WEST LAFAYETTE, Ind. -- Nurses today are learning how to mix a little cultural understanding with the medical care they offer.
"Nurses don't have to travel to faraway places to encounter challenges stemming from cultural diversity. American society provides plenty of opportunities," says Sharon Posey, a national expert who is an associate professor of nursing at Purdue University.
Posey, who spent three weeks in May on the Navajo reservation in northern Arizona with six students in community health experiences, says such first-hand experience is the best way to help nurses learn about different cultures so they can adjust their nursing care to the sensitivities of people from diverse ethnic backgrounds.
She will talk about her experiences and how other schools can develop similar programs Oct. 30 during a national conference on professional nursing education in Bellevue, Wash.
"In our society, nurses will encounter all sorts of cultural differences, such as ethnic customs, traditions and taboos," Posey says. "Knowing something about a culture is a decided advantage in working with a patient with a background in that culture."
Often, she says, a nurse trying to help an injured or ill person meets resistance from the patient or from the patient's family that makes treatment difficult, if not impossible.
"With many people of other cultures," Posey says, "language is often a problem, but we can usually work our way around that with sign language of a sort, or a translator. But it's the ethnic traditions, customs, taboos -- the often deep-rooted beliefs of a culture -- that really can challenge a nurse in doing what he or she wants to do to help the patient."
For example, trying to treat a Vietnamese person with head injuries can present a problem.
"Some Vietnamese consider the head to be sacred and housing the soul, and touching the head can allow the soul to escape. If treatments require that you touch the head, you're going to have to look for alternative ways of doing what you have to do, or carefully explain why it is necessary to do it."
Posey says some Chinese may veto lab work that requires drawing the patient's blood, often critical in diagnosis, and may refuse surgery that could literally be a matter of life or death.
"They believe blood is the source of life," Posey says, "and that taking any of it could lead to their death." She says they also view their body as a gift from their parents and believe it should be maintained as a whole and not be cut or have parts taken from it.
Nurses working with Mexican children, says Posey, might encounter belief in the supernatural held by some Hispanics -- the "evil eye." "They call it 'mal de ojo'-- the 'bad eye' or evil eye," Posey says. "They believe that if someone looks at a child for any amount of time without touching the child, that person has cast a spell -- an 'evil eye' -- on the child. So it's important for nurses working with these children to touch them immediately."
Posey, who has observed health practices in India, Thailand, China, Mexico, Brazil and Costa Rica, says family roles also may be a factor, especially in societies where the male is dominant.
"It might not be possible for a female Asian Indian patient to authorize treatment, even if she is conscious and able to speak," Posey says. "The nurse may have to seek permission of the husband or father before treatment may begin, even if it is seen as critical."
A very common problem, she says, has to do with the way different peoples deal with pain.
"We know certain cultures -- Greeks, Italians and Hispanics, for example -- are most expressive emotionally, while Asians and American Indians tend to be very reserved," she says. "To assess pain in an Asian, it might be necessary to question the person often, because the pain might not be apparent to the nurse."
For the past seven years, Posey or her colleague Pam Aaltonen have taken a half-dozen students to Sells, Ariz., to work with the Public Health Service on the Tohono O'odham Reservation. This year, she and her students traveled to a site in the Monument Valley area to work in the Community Health Clinic on the Navajo reservation.
Students pay their own travel fare, and the Indian Health Service provides housing on the reservation. Support from Purdue is used to help with transportation costs at the site.
Working with the Navajo people was especially educational, Posey says, because many of their cultural practices are easily observed.
"We visited a woman who was experiencing difficulties late in her pregnancy, and we suspected that this might be a breech birth," Posey says. "We wanted to examine her and, if necessary, make preparations to have her transported to the nearest hospital, which was 70 miles away."
When the students asked the woman to come to the clinic for a checkup, the family declined, saying that they wanted to wait until a ceremony could be performed by a medicine man.
"The local nurses told us that, in some instances, breech babies have turned after a ceremony was performed," Posey says. "For the students, this event illustrated how some cultures rely upon their traditional beliefs and way of life, and how cultural beliefs and values play a role in health care."
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