America has been a place where people from all over the world come to create better lives, especially through health care. As a nurse, patients come in all shapes, sizes, colors, and orientations – all of them needing your help. With an increasingly diverse population, multicultural nursing is more important every day. Being able to respond to a patient’s cultural, informational, and linguistic needs can be all tall order – not to mention helping them gain access to preventative services.
What’s Involved with Multicultural Nursing?
As with most professions, the approach to gaining a better handle on the current state of an industry starts with education. Gaining a higher degree of multicultural nursing expertise means recognizing what improvements can be made and better equipping new nurses with skills in these areas.
“The boundaries are melting,” said Beverly Malone, PhD, RN, FAAN, and CEO of the National League for Nursing (NLN) in New York. “We have to prepare nurses not just for the U.S. but for the world.” With changing demographics and underrepresented Hispanic, Latino, and African American nursing professionals, organizations like the NLN are working to change that with their initiatives and resources for students to better prepare themselves for multicultural patients.
Generally, people will feel more comfortable when they see a physician or nurse of their same background, hopefully prompting them to continue seeking medical attention when appropriate. Yet, beyond surface appearances, learning how to respond to the world’s vast array of cultural preferences can be quite the task. So what should professionals seeking to increase their multicultural nursing skills look for?
Personal Space and Distance
It is a general consensus that people consider the space immediately around them as an extension of the self. This means the amount of space between others and the ability to feel comfortable is a relatively cultural phenomenon and will vary. In some instances, sitting near a patient may amount to them perceiving this as an expression of warmth and caring, whereas other may feel invaded.
Most people are not usually conscious of their cultural idea of personal space, amounting to more of a feeling. And while not everyone from a respective geographic area or culture will share the exact same preferences, research suggests that people from the U.S., Canada, and Great Britain require the most personal space, while people from Latin America, Japan, and the Middle East feel more comfortable standing close to others.
Another culturally determined behavior, eye contact can be a very important aspect of communication with patients. Even though most nurses are trained to maintain eye contact while speaking in order to gauge a patient’s understanding of information, people from Asian, American Indian, Indo-Chinese, Arab, and Appalachian cultures may regard direct eye contact as impolite or even aggressive.
Avoiding eye contact can indicate that you are regarded as an authority figure and that a person is actually listening more intently. Recognizing which cultures may maintain these behaviors is a good way to avoid misunderstandings and accommodate patients more effectively.
Time and Punctuality
Attitudes regarding time can vary widely among cultures, especially concepts of punctuality and wait times. As Americans, we’re usually pretty critical of wait times and promptness is extremely important. Patients need to arrive at an exact time – even if they are to sit until staff members are ready to see them. With people from other cultures, time may not always adhere to the exact minute or even the exact hour.
While this can be frustrating on a hectic schedule, scolding or acting annoyed toward a patient won’t likely yield better results than were you to adjust and adapt to the situation. Yes, if everyone was on time for every appointment we’d have a bit of a smoother system, but for now we’ll just have to work within reality.
Touch is something that nursing demands but varies greatly in terms of cultural perspectives. Furthermore, religion and one’s personal beliefs can also determine the appropriate level of touch, especially between the sexes. In Hispanic and Arab cultures particularly, examining or touching certain parts of the female body are prohibited. For Jewish and Islamic women, modesty means covering the head, arms, and legs with clothing so working within this framework can be vastly important. In other cases, touching the head of those from Asian cultures (especially older generations) may be considered impolite. Always be sure to communicate exactly what you are planning to do and whether or not the patient is comfortable proceeding.
Of course, these are not all of the possible cultural considerations nurses should make, but they represent good starting points for learning about the preferences of others. Dietary restrictions, body language, cultural holidays, and philosophies on medicine are other areas to consider when caring for multicultural patients. It may be hard to know whether you’re 100% correct in your assessment of someone’s cultural preferences, although keeping communication open and asking questions is key to providing the best multicultural nursing care possible.