Nurse: "Tell me what concerns you have at this time?" (giving eye contact)
Therapeutic: Exploring
Patient: "I have been so busy at school that I don’t have time for my children" (looking down)
Nurse: "I know what you mean, I have a hard time keeping up with school too. (leaning forward) How do you think your children feel about your being gone?"
Non-therapeutic: Ignoring/changing subject
Better response: "How do you feel about not having enough time for the children?" (exploring)
Example 2:
Patient: "Well, they don’t understand why I have to go to school every day and cry when I leave home." (looks worried)
Nurse: "That must be difficult for you. Have you tried giving them special one on one time each day?"
Therapeutic: Accepting
Non-therapeutic: Giving advice
Better response: "Tell me more." (general lead)
Non-Therapeutic Actions
It is not therapeutic to:
Focus the conversation on yourself.
Lead the conversation.
Change the topic:
Changing the focus of the topic.
Bringing up what you think they should focus on.
Take the conversation to a superficial level.
Formulate a plan too early.
If a non-therapeutic statement is made:
You must include a better response.
Helpful Hints
Communication Techniques:
Refer to Table 6.1 (pp. 100-103) for selecting communication techniques.
Review both the example and the rationale to ensure correct usage.
Learning Opportunity:
Use this as an opportunity to learn the terms.
Concluding Paragraph Content
Reflect on the interaction before learning about therapeutic communication techniques.
Assess if your PR analysis agreed with your initial assessment.
Describe what you learned about your communication with others.
Identify your strengths.
Identify areas where you could improve.
Reflect on whether therapeutic communication came naturally or was difficult.
Describe what you learned from your partner’s analysis of your communication and PR.
Discuss how you can apply this insight to your practice.
Cultural Diversity
Learning Objectives:
Define terms associated with cultural diversity.
Compare Joyce Giger’s Six Factors of Cultural Assessment.
Discuss how nurses should respond to a patient’s cultural health practices.
Identify cultural variables that influence the delivery of healthcare.
Identify significant beliefs, perceptions, and values of specific cultural groups.
Concepts of Culture
Definition:
Shared system of beliefs, values, and behavioral expectations that provide social structure for daily living.
Roles and Interactions:
Defines roles and interactions with others, within families, and communities.
Manifestation:
Apparent in the attitudes and institutions unique to particular groups.
Elements:
Includes beliefs, habits, likes, dislikes, customs, and rituals learned from one’s family.
Behavior Guidance:
Guides behavior into acceptable ways for people in a specific group.
Origins:
Cultural practices arise through the group’s social and physical environment.
Belief Systems:
Different belief systems affect a patient's expectations of how care should be given.
Constancy & Evolution:
Cultural practices and beliefs may evolve over time but remain constant while they satisfy a group’s needs.
Influence:
Influences how people of a group view themselves, their expectations, and how they behave in response to certain situations.
American Expectations:
Specific expectations of behavior for hospital care, care of children, elderly care, etc.
Ethnicity
Definition:
Sense of identification with a collective cultural group, largely based on the group’s common heritage.
Membership:
One belongs to a specific ethnic group either through birth or through adoption of characteristics of that group.
Shared Characteristics:
People within an ethnic group generally share unique cultural and social beliefs and behavior patterns.
Examples:
Language and dialect, religious practices, literature, folklore, music, political interest, food preferences, employment patterns.
Concepts of Culture: Stereotypes & Prejudice
Stereotypes:
Assuming that all members of a culture or ethnic group act alike.
Can be either positive or negative.
Prejudice:
Negative stereotyping that believes a certain race, age group, or gender is inherently superior to others.
Leads to discrimination against those considered inferior.
Often done by members of the dominant group about the minority group.
Joyce Giger’s 6 Factors of Cultural Assessment
Factors:
Verbal and Nonverbal Communication
The Person’s Need for Personal Space
Biological Variations
Time Orientation
Social Organization
The Person’s Perspective on Environmental Control
Source:
Giger, J., & Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. St. Louis, MO: Mosby.
Important Factors in Cultural Assessment
Communication:
Verbal (language differences)
Nonverbal (eye contact, gestures, etc.)
Social Organization:
Family structure and organization (importance of family, family members roles, nuclear and extended family)
Physical Distance or Space:
Personal space (influenced by various settings or circumstances)
Time Orientation:
Time orientation (past, present, or future) – How important is it to be on time?
Environmental Control:
Internal or external locus of control
Biologic Variations:
Biological variations associated with a specific culture
Cultural Variables Influencing Healthcare Delivery
Gender Roles:
Knowing who is the dominant member of the family is an important consideration when planning nursing care.
Language and Communication:
Languages and dialects
Nonverbal communication (gestures and eye contact)
Food and Nutrition:
Food preferences and how foods are prepared vary among cultures.
Socioeconomic Factors:
Income potential
Access to social advantages such as healthcare, housing, education, etc.
Family Support:
Respect and value of family members varies among cultures.
Physical and Mental Health:
Influenced by ethnicity and cultural values
Possible Effects on Cultural Health Practices
Efficacious (Helpful)
Neutral (Neither Helpful nor Harmful)
Uncertain (Unknown to you)
Dysfunctional (Harmful)
Improving Cultural Competence
Key Intervention:
Routinely ask patients what matters most to them in their illness and treatment.
Reference:
Wilkinson, J. M., Treas, L. S., Barnett, K. L., Smith, M. H. (20200. Fundamentals of nursing (4th ed.). F.A. Davis.
Presentation Reminders
Be respectful and nonjudgmental.
Provide a handout with key points related to Giger’s 6 Factors (must include references).
Culture Presentation and Handout Slide Topics:
Communication:
Language
Nonverbal
Gestures
Space:
How much space is ideal
Touch
Social Organization:
Family organization
Gender roles
Respect for elders
Family role in hospitalization
Time:
Past, present, future
Prompt or late
Environmental Control:
External locus or internal locus
Beliefs about disease
Herbal supplements
Western or eastern medicine
Biological Variation:
Health problems
Diet
Mental health stigma
Disparity, socioeconomic issues, access
Religion Presentation and Handout Slides
Spiritual Beliefs:
Belief in God/s or Higher Being
Beliefs about health, illness, death
Diet and Health Practices:
Birth, death, sickness
Diet, health code
Spiritual Needs:
Spiritual advisors
Sacrament, baptism, blessings
Spiritual Aids (prayer, bible, beads)
Daily Schedule and Practice:
Daily spiritual needs
Religious holidays
Folk practices
Gender Roles, Family Roles, Social Support
Other (language, communication)
And whatever the nurse REALLY needs to consider!
References
Giger, J. N. & Davidhizar, R. (2002). The Giger and Davidhizar transcultural assessment model. Journal of Transcultural Nursing, 13(3), 185-188.
Wilkinson, J. M., Treas, L. S., Barnett, K. L., Smith, M. H. (20200. Fundamentals of nursing (4th ed.). F.A. Davis.