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Cross-cultural communication, Essay

The purpose of this essay is to use reflection on an aspect of my learning that I have come across so far as a student nurse, and how I plan to use this knowledge when I start my placements. This will give me a good base on which to build my interpersonal skills. After having a brief introduction on various religions, it brought to my attention the diversity in multi cultural societies and how, as a nurse I need a good understanding of treatment and communication barriers that I will come across.

The United Kingdom (UK) has welcomed a mixture of ethnic groups, each bringing with their own culture, with their own language. Multiculturalism is an ideology that promotes the institutionalism of communities containing multiple cultures. I have taken it upon myself to find out information to gain more knowledge on different religions, values and beliefs, and the different aspects of care this relates to. This will then enable me to support patients and their families more efficiently, effectively and in a patient centred manor.

In terms of using reflection throughout this essay, I Plan to use Gibbs Reflective Cycle (Gibbs 1988). This will help with structural preferences. I will also be reflecting individually on some of the knowledge I gained. Reflection aims to bridge the gap between theory and practice to show the interrelation of skills and knowledge. Reflection relates to me as a student nurse as suggested by Hargreaves (1997 pp.04) “that reflective practice is often included in professional education programs as a way of encouraging practitioners to critically evaluate their behaviour, beliefs and ideas on practice”. She states that this will lead to improved clinical expertise and, consequently, improve nursing care.

The first Lecture I received on Religion was an Introduction to the chaplaincy team. They provide spiritual guidance for anyone needing advice, courage and support. Wittenburg-Lyles E, (2008) explains that The Chaplaincy team are able to provide visits to local places. This lecture increased my awareness of faith and moral issues. During my placements, I will come
across many different cultures and religions. This is when I realised I needed to do a lot of research into different faiths to enable me to support my patients and their beliefs. I was given an example that I may come across. Some religious belief in praying on their knees, if a patient for some reason needed to have their leg amputated, this would then effect a certain aspect of their life. Therefore I would need to support them in a way that they could still meet there religious needs. I will reflect on this in practice by widening my knowledge on different religions.

Next, we explored Morals, Values and beliefs; here I learnt about the responsibilities I will have as a nurse, for example, how to respect patient’s dignity and privacy (Baillie, 2011). I have an understanding that each individual is unique. I will reflect on this in practice by treating each patient as an individual. Regardless of their race, ethnic, gender, sexual orientation, age, physical abilities, religious beliefs or political beliefs.

Thirdly in another lecture, I was introduced to two service users and cultural perspectives in health care. A Buddhist from the Chaplaincy service came in to the university. I found it very interesting finding out some Buddhism’s beliefs. For an example, death is inevitable and Buddhists like to prepare for death when meditating. Buda’s also like to carry a small Buda, picture of a Buda or beads for chanting to remember their teacher. We then had a talk about Christianity from a Catholic Farther. I learnt that there will be dietary requirements inside Christianity, as some Christians will only eat fish on a Friday, no meat.

They also like to carry on them a symbol of Christianity. That may be beads, holy water or a wooden cross. Christians do not like to be overly exposed during personal care needs. This has now widened my knowledge on two different religions. I shall reflect on this by taking the knowledge I have gained into practice, for when I come across patients with these beliefs. As a nurse sometimes there will be conflict when it comes to religions of employees but you must not to be judgemental, (Nursing and Midwifery council (NMC), 2010). Because of being a nurse, this is mainly due to infection control. Some staff maybe asked to remove clothing or jewellery, which could be against their religious
beliefs, although head wear is now allowed for nursing and doctors. Some would argue this is discrimination, as some can get away with it. I think this is a typical example of how religious beliefs can also affect staff as well as patients and relatives. NMC (2010) states that as a nurse I may recognise diversity and respect with cultural differences, values and beliefs of others including the people you care for and other members of staff.

I feel the lectures I attended were very interesting, it was not until this point that I realised it would be a very interesting topic to reflect upon and learn more about. Both the Buddhist and the Christian, were very helpful when anyone wanted to know anything, they both leased with the class at the start of their lecture by making a plan of what, we as a class wanted to cover throughout the duration of the lecture. I do feel that I held back too much when it came to questions at the end and could have asked some more questions myself, all though others asked similar questions to what I was thinking.

The information I gained during these three lectures has been useful. But I felt as if I still needed to widen my knowledge further by doing some research. I believe the first step is to be self aware of my own cultural beliefs. Being self aware is crucial as will identify any prejudices or attitudes that could be making a barrier in front of good communication, best practice and patient advocacy. Festini F (2009) comments that, Effective communication is the main aspect of delivering culturally competent care. This is where I needed to reflect upon myself by looking into the Johari Window and the four Quadrants. Being self aware is a two way process. If we do not know who we are, we don’t know how we appear to others. This made me realise I need to become more confident in myself when asking questions in front of my group. This will take time with feeling comfortable.

Throughout my learning on this topic so far, it has been very useful to see where my knowledge is lacking. I know need to research further into this topic. It has given me the incentive to widen my knowledge. These lectures on religion have been an eye opener. I have realised there is so much complexity in relation to region and different faiths that as a nurse, I will need to know about. Previously I would have had no knowledge on this. I will improve on this by using a range of research ideas to gain knowledge which will then increase efficiency, I will continue to reflect on this area in order to develop as a nurse.

It was at this point I realised that although the information that I have gained so far has been more than useful, it did not answer all my questions. As I still need some more guidance on what to do in situations I may come across when out in practice, whether this may be communication or treatment barrier issues.

Morals are influenced by cultural values, beliefs and religion, not only by the law (Griffith and Tengnah, 2010). Morals values and beliefs and assumptions influence healthcare. I understand that cultural and language barriers can complicate situations. As a professional I must have the ability to interact effectively with clients and other professionals. During social interaction, I believe that nurses should avoid stereotyping when caring for patients from different cultures, suggested by Alexis, (2011).

I have come cross a few patients from different religions with their own languages whilst I have been working in care. When communicating with a patient that does not speak English as their first language, care can be compromised if effective communication is not used. When explaining something to the patient, there needs to be a balance between using simple sentences without being patronising. For example I would ask do you hurt anywhere, or are you in any pain? Instead of saying, are you in any discomfort? I would encourage staff not to use as many medical terms, I understand this may otherwise be confusing and distressing for the patient. I would only ask one question at a time to avoid overwhelming the individual. When asking patients these questions, I must also understand a patient’s cultural perceptions and experiences regarding pain (Magnusson, 2011). I can reflect on this when I go into practice by involving their
cultural perceptions when decision making on pain relief.

I think sometimes a quiet time is a good time to access your patient’s communication skills. I would then have more time to look at their non-verbal clues, posture, facial expressions, is there any eye contact used or maybe there are signs of anxiety. When situations arise around communication barriers I work with other members of staff, the patient’s relatives and different members of the multidisciplinary team so that I can find out the best ways possible to communicate with them, and any particular activities of daily living or rituals (Roper, Logan and Tierney, 1998), that are important and relevant to their cultural needs. In some of my findings, I came across some good examples of how there could be a barrier between you and your patient in terms of personal care. I found that some patients do not feel comfortable if they are being touched by the opposite sex.

Others dislike their heads being uncovered, they must keep it covered with clothing for modesty. These views come mainly from Jewish and Islamic religions. I found it very interesting to know that two different religions may not like a certain part of care to be carried out but for two completely different reasons. Asian Americans do not like any touching of the head as their view is that it is impolite, as they believe that their spirit resides there. I found out that in some cases all you need to do is ask for permission. This reflects back to good communication skills.

I consider the main objective of communication between the nurse and patients is that messages are understood accurately. My research told me that most health agencies have access to medical interpreters for major languages. There is usually a member of the family that maybe helpful by speaking English, but they are not as reliable as interpreters, explained by, Griffith, (2009). Another reason why not to use a family member as an interpreter is that they might only translate the bits that they want the patient to hear and not the full story. I understand that if there is a family member interpreter or a professional interpreter, the potential for misunderstanding can increase. I found the information from Ting Toomey (1999) very interesting for this. She describes three ways that culture can interfere with effective cross cultural understanding. These being,
Cognitive constraints, Behaviour constraints and Emotional constraints.

I believe that it is crucial that all staff should document the specific communication skills that are needed with each individual patient and the patient’s response. As suggested by Festini, (2011). Weather this be in the medical record or a care plan. In my past experiences it is also crucial that these affective communication skills are past on through handovers, which increases the opportunity for successful staff-patient interactions, (Randell, 2011). I plan to take my ideas and past experiences into practice with me. As I feel it works brilliantly and is effective in terms of meeting patients, beliefs and preferences. I am also aware that each placement I go to may have a different way of doing things. I look forward to gaining new knowledge that may better my communication skills for people with cultural preferences.

It is also essential to remember privacy when assessing a patient from a different culture. A quiet setting is always best, most importantly somewhere where you will not be disturbed. This is where I would utilise my background knowledge into different religions, and use different strategies with in my knowledge. For example, some religions do not like direct eye contact. I read more into this when I spoke to some of the students in my class, as some of them are from different cultures. One from Zimbabwe explained to me that in Zimbabwe they only look people into the eye when they are looking for a fight or trouble.

He also explained how he had to change his perception of others looking at him when he moved to the UK as every English man he came across looked into his eyes, this at first was scary for him, but he is now okay with it. This has brought to my attention that although this cannot be avoided, I as a nurse should still be respectful to their beliefs and consider the patients preferences. I also researched some of the decisions that patients make in connection to religious beliefs regarding treatment. Law can be used to challenge the decisions a parent or next of kin (NOK) decides but this usually only happens when the treatment is life saving.

The NOK or the patient themselves need to be able to make an informed decision in order to give consent or refuse treatment. I am aware that some religions refuse certain life saving treatments, and understand my role as a nurse is to advocate in my patients best interest, inform the patient or NOK of treatment options and consequences of refusing treatment. Emergency situations will not arise everyday in my nurse training or career, but I have more knowledge of my role should I be faced with this type of situation.

Where religion may sway a patient’s decision all other options for treatment should be considered (Haan, 2005). As a nurse, it is my job to ensure my patient has an advocate, alternatives, and support to understand consequences of treatments and what will happen if they refuse.

Initially I was unsure of which area of my learning I should reflect upon. After having worked in care previously, I felt looking into religion would not only be something good to reflect on but something interesting I could also learn upon. After everything I have learnt within this topic so far, I have gained a new perspective on religions, morals and beliefs. .

I wasn’t sure whether I was going to use a reflective model because I wasn’t sure if it was going to be appropriate as it is very structured. Once I had started to educate myself on a Multicultural Society and throughout planning my notes I began to realise how helpful it was to have a structure, I was able to structure my notes into different sections which proved to be very useful.

Throughout writing my essay I have learnt to have a lot more belief in myself and the ability I have in writing an essay. But I have been able to identify my lack of knowledge on religion and culture. I think social issues will arise when staff members have a lack of understanding and knowledge of different religious beliefs, other than their own. This gave me the incentive to learn and research more to gain a better understanding, and widen my knowledge. Therefore I will be able to educate other nurses. I belief I could still now, expand on this knowledge further and I plan to do this throughout my time as a student and in my future career.

Action Plan
My action plan will include and implement a method of reviewing everything that I have learnt from past experiences and research, thereby using reflective thinking. I will be apply the knowledge I have Learnt and encompass this in practice as a student nurse and also a registered nurse, which will help me become a safe and competent practitioner. If I was to come across a patient with specific religious beliefs I feel I could support them as well as their family by, not only by ensuring I provide good holistic care but also allowing them to maintain a good link with their religious beliefs.

If I was to come across a patient that I could not talk to, I would use past experiences by using models and pictures which to a degree would be a great help. This would help the patients to identify their treatment procedures or help me to identify their needs. I understand that some patients I meet may have a family member that may make the decisions as their next of kin, or medical power of attorney. I believe I would also need to communicate well with the family member. I would take into consideration maybe a spiritual advisor, not just painkillers as a healer. In some people’s eyes, their god or spiritual leader is their way of healing.

If in my career I come across a child patient for example in A&E, which had a religion barrier in the way of treatment. I would have to support certain legislations to ensure the refusing of medical treatment did not cause death, if parents deny this; I would have to involve other professionals.

From my findings I now have good cross cultural communications skills, this can enhance my nursing. I could build the patients confidence in situations I may come across. By being aware and alert I feel I could improve the patient’s safety and wellbeing by minimising any cultural differences. I will enable my patients to continue with their religious practice whilst in a health care setting. “Word Count: 3004”

Alexis, O. 2011. Health and cultural sensitivity in a diversifying society.
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Haan, J., 2005. A Jehovah’s witness with complex abdominal trauma and coagulopathy: use of factor VII and a review to the literature. American Surgeon, 71 (5), pp. 414-5.

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Wittenberg-lyles, E., 2008. Communication dynamics in hospice teams, understanding the role of the chaplain in interdisciplinary team collaboration. Journal of palliative medicine, 11 (10), p.336.

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Nursing and Midwifery Council, 2010. Standards of conduct, performance and ethics for nurses and midwifes, London: NMC

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