Guided Dialogue

For this task, I chose to reflect on an episode that occurred during my clinical placement and helped me develop a new understanding in relation to trans-cultural nursing in terms of communication and engagement. I chose this scenario because it illustrates how Communication Cultural barriers may appear greater when accompanied by a language difference. The effectiveness of communication depends on each party's clear understanding of the meaning of each message.

Communication is an essential component of any nurse-client interaction (Burnard, & Gill, 2008 p. 2). The process of communication aspects of both verbal and non-verbal components and may be influenced by culture, hierarchical relationships, gender, and religion. Nurses today are facing a world in which they are required to apply trans-culturally based nursing concepts and practices so as to care for patients from diverse cultures (Leininger, 1996; Duffy, D. 2006). A care with cultural content prevents both the patient and the nurse from experiencing a cultural shock and it also enhances the healthcare service quality (Cioffi, J. 2006, P. 320). A care with cultural content prevents both the patient and the nurse from experiencing a cultural shock and it also enhances the healthcare service quality (Helman, C. 2007 P. 3). Leininger (1999) defined trans-cultural Nursing as an area of formal study and practice that focuses on comparison of diverse cultures, health, care, and illness patterns of each group, putting into consideration the diversities and similarities in their cultural practices, values, and beliefs with a goal of providing culturally congruent, competent, and sensitive healthcare to people of diverse cultures. As a matter of fact, the healthcare practitioners may have to attend to people whose worth judgments are totally different from theirs (Hull et al. 2005, P. 65). For instance, people who migrate from their country of origin to another country bring with them beliefs and cultures about sickness, health and medical care that may be strange to local health care providers (Robinson, 2002, P. 12). Cultural diversities influence these patients' preferences about health care in ways that local nurses may consider unsuitable or even risky. Previous related studies on trans-cultural nursing show that the awareness of cultural distinctiveness has a positive influence on the nursing practice (Spector, 2004). A care with cultural content prevents both the patient and the nurse from experiencing a cultural shock and it also enhances the healthcare service quality (Pinikahana et al., 2003).

Thus, in my reflection assignment, I will discuss a patient scenario that had a cultural and linguistic dimension and that helped me to develop a new understanding in relation to trans-cultural nursing in terms of communication and engagement. In this context, it is important for me to perfect my cultural and linguistic competence (Papadopoulos, 2006). This refers to my ability as a health care provider to be able to understand and counter the linguistic and cultural needs of my clients during the health care encounters. For example, culturally diverse patient may need an interpreter staff, translated reading materials, clinical and subordinate staffs, who know how to inquire about cultural issues and also to negotiate them, be able to appropriate food choices, and other measures. Addressing cultural diversity has the prospective to improve patients' outcomes as well as the cost efficacy and efficiency in delivery of health care services. 

My reflection is about one of our client whom I code as Mrs. X. This is not her real name but a code to serve to protect her confidentiality.  In this section I will describe the scenario that took place and give details of the events as they unfolded during my clinical placement. I went to the clinic with the school nurse to give BCG injection. One of our clients, an Asian lady came with her little boy but we found out she can hardly speak any English but just a few words. We could clearly see she did not understand whatever we were trying to communicate. It was challenging for the nurse and for me as tried to establish an effective means of communication with our client. However, we could tell that she wanted us to give the injection because she bought her little boy- however this was an implied communication.

We could not give the baby the injection until we made sure that everything was clearly communicated and that all components of communication were truly affected. We had to explain very slowly to Mrs. X and it was after a lot of verbal communication that she understood what we tried to say to her. We advised her to go home and bring somebody who could speak English to act as an interpreter. We also advised her that if she did not have anybody who can assist her, we can make another appointment in advance for her and call language line or Refugees in effective and active partnership (REAP). We also had to write down all this information for her to take it home and show it to somebody who can speak English. Later on she and her husband called and made another appointment and asked for a translator.

In this section, am going to discuss on my thinking and feelings towards what took place in the unfolding scenario as it happened. It was my first time when I experienced the language barriers and I felt good because I felt part of the team to help Mrs. X not too feel uncomfortable. I felt sorry for her but it was a good experience for me to see how well the nurse dealt with the situation. It did not take long before we established that Mrs. X could not communicate properly in English. Besides the language barrier, the dissimilar cultural orientation and lifestyle also emerged to be a multifactor challenge for many immigrants- like Mrs. X, living in a foreign nation and the language barrier only served to blow up this effect. Her Asian background and the associated cultural diversities obviously influenced her preferences about health care. Persons from a particular cultural tradition that differ from the prevailing culture may view the local medical practices as strange. I found out that there exist some underlying trans-cultural nursing issues between Asian people living in America and the American health care personnel. The meanings of illness, disease and health are not necessarily clearly defined in the same way in these two cultures given that these meanings are part of everyday life.

I also observed that various disease causes are proposed differently between the two cultures. For example, people from Asian origin usually believe that most diseases have both spiritual and bodily causes while Americans generally believe that diseases are caused only by bodily reasons. People from her Asian community do not like to talk about illnesses and death because these are considered taboo topics. Traditionally, they were not knowledgeable about disease causes and many of them believed that some diseases came as a punishment from God and that nothing could be done to cure it.

For the people from dissimilar cultures to freely express themselves, it so much requires building of a good rapport so as not to make them feel as strangers.  That is exactly what we; me and the nurse, were trying to do. In our approach, we tried to give Mrs. X assurance that we well understood the difficulty and frustration over the inability to communicate. In doing this, we maintained a calm and positive attitude as we reassured her that we can work to overcome this difficulty. During the initial assessment, we started with general questions; allowing time for her to talk even if we could hardly understand what she was saying. At the initial stage, we used non direct, open ended questions when possible, and we delayed asking very personal questions.  

Since Mrs. X could only understand very little English, we talked to her using very simple words. We also used gestures and pictures to explain to her what we were saying. We also applied non-verbal communication in the form of smile was well understood. I noted that an attempt on the part of the nurse to communicate over a language barrier encourages the client to do the same.

We made Mrs. X understand that she required an interpreter. We advised her to go home and bring somebody who could speak English to act as an interpreter. We also advised her that if she did not have anybody who can assist her, we can make another appointment in advance for her and call language line or Refugees in effective and active partnership (REAP). We also had to write down all this information for her to take it home and show it to somebody who can speak English. Later on she and her husband called and made another appointment and asked for a translator.

Interpreters are used in clinical settings to help patients and health care giver to communicate (Burnard, & Gill, 2008 p. 62). It is quite common to use available bilingual family members or friends as an interpreter when communicating with clients. Our advice to Mrs. X to seek for a family member to act as her interpreter was based on the assumption that she could easily get one. In addition, family member or a friend will also serve as sources of client and cultural information since they know the client to an extent or be from the same social-cultural background, which may be comforting to the client (Sully & Dallas, 2005). However, when using family members or friends as interpreters, they can compromise communication and ultimately affect client care. A family member may be inclined to base his or her messages to both the client and the caregiver on their own interpretation of the situation, and may withhold vital information they may think it is embarrassing to them or to the care giver. They may also lack the ability to understand healthcare terminologies and procedures as they may not be able to speak and understand English well.     

Refugees in effective and active partnership (REAP) is a voluntary group that purposefully empowers local immigrant communities. They often offer voluntary services and this includes voluntary interpreters from community agencies and local neighborhood affiliations. Mrs. X could qualify for such services. Interpreters are also available for inpatient units and their services and may be requested by calling the language line. The service offers over 140 languages interpretation services over-the-phone and is accessible 24 hours a day, seven days a week. Rates are charged by the minute.

We needed to ask for permission from the line manager to use language line or REAP. We also had to put everything down for record keeping and documentation in computer system. The institution uses RIO computer based record system.

As a result of cultural disparity-as was the case here, the inclination of ethical care calls for different components (Tanriverdi et al, 2009). Nurses should be aware of, or be skillful in order to understand such disparity in beliefs about illness. To assist in recovery from an illness, health care providers need to be aware of and use patients' understanding of their illness while helping them to comply with the treatment at the same time (Dogan et al 2009). According to one American hospital nurse, one great problem that nurses encounters when attending foreign patients is caused by their lack of knowledge as regards culturally determined thoughts of illness and health, and inadequate adjustment of these patients to the American culture and hospitals (Dogan et al 2009). The major one source of these problems was is the inadequate appreciation of other cultural and ethnic groups on the part of nurses, which has led to attitudes characterized by stereotyping, intolerance, utterances and behaviors highlighted by cultural prejudice and the transfer of guilt to alien patients (Dogan et al 2009).

This study has helped me to understand trans-cultural nursing in terms of communication and engagement (Burnard, 2002 p. 2), which is essential in providing a basis on how to relate to those patients from a different cultural background; and to explore how Communication Cultural barriers may appear greater when accompanied by a language difference, and how it affects interactions with the patients. This also helps me to acknowledge that expectation between the patients and providers may differ, which is also a significant step in developing cultural competence.

With this understanding, I can recognize and appreciate cultural differences and Communication Cultural barriers as far as Asian trans-cultural nursing is concerned so as to ensure patient satisfaction and positive outcomes. As health care providers, we need to be aware that effective communication does not only occur from speaking a similar language, but also occurs through body language and other cues, for example, tone, voice, and loudness. To achieve this, there must be a willingness to get along with each other and it is also important for a Health care provider or a nurse to recognize his or her own cultural biases and behaviors.