Transcultural Nursing: Best Practices for Effective Communication

The Barriers to Transcultural Communication in Healthcare

1.Clearly Identify a Problem relevant to a group/organisation and discusses what evidence-based Information has been found relevant to best-practice as a solution.

2.Clearly Identify Ethical Implications associated with the proposed research project  based on relevant studies. 

Transcultural communication is difficult to be implemented in health care as the patient’s expect the health care professions to understand their preferences. On the other hand, the care providers face difficulty due to linguistic barriers, and missing of non-verbal messages, even when the translators are present. It is the common issue where the health care professionals fail to acknowledge the similarities and differences in people from culturally diverse background (Holland 2017). Australia being the multicultural society demands Transcultural nursing in the health care organisation. The crux of Transcultural nursing is good communication between the health care providers and the patients. Communication in Transcultural nursing refers to acknowledging the individual’s culture, beliefs and practices. It is the best practice necessary to bridge the cultural gap. It will ensure the acceptable Transcultural care. Various strategies have been developed to address this issue but there lies an uncertainty about communication change. This issue has been prominently highlighted in the recent and old peer review journals (Giger 2016).  In regards to the issue, the essay discusses the relevant literature pertaining to the issue and the evidence based information regarding the best practice as solution.

1.As a research manager, I have identified from my research that in Melbourne hospital, a client of refugee background was admitted to emergency department. He was suspected with TB and was isolated. There was no hospital staff that spoke Kirundi, Swahili or Congolese languages. Since, the patient’s children spoke English no interpreter was recruited. Later a social worker who visited the client arranged for an interpreter. It was discovered later that the client was afraid of dying of AIDS, which was then highly prevalent in Africa (Professionalsaustralia.org.au 2017).  

In the health care industry, I have observed that the professionals have to interact with peers and patients from different cultural background. Thus, nurses require communication in different forms to advocate their patients. When nurses fail to communicate with people from culturally and linguistically diverse communities, the patients interpret it as bias, prejudice, consequently influencing the quality of care.

The best practice solution to the barriers in Transcultural nursing is the cultivation of the cross-cultural communication skills. According to Taylor et al. (2013), there must be efficient and skilful use of the interpreter’s cultural competency. Interpreters, nurses and physicians must learn the culturally competent communication skills both verbal and no verbal.  These skills are required to identify the patient’s values, practices, beliefs, unique health care needs and perceptions.  These skills are required in all types of health settings may it be palliative, geriatric care, mental health, paediatric and any other setting. It includes use of basic grammar, simple and common words, knowing the multilingual signs, bilingual words and phrases, pictograms, and asking politely for paraphrasing important points. Cultural competency while communication includes starting a statement with “Is it clear or can you understand”. The literature also suggests that there is a need of culturally fluent approach for nurses to cultivate good communication skills in nursing. Other factors necessary to implement this solution are awareness, sensitivity, good listening, and patience. It will help improve the communication across cultures. It will also ensure the personal and professional relationships (Silverman et al. 2016).

Best Practices for Effective Cross-Cultural Communication in Nursing

Various strategies, models and theories have been developed to improve communication style in Transcultural nursing. However, there are barriers to implementing theory into practice. For instance, a Middle Eastern patient in ICU may suddenly wake up and request seriously to pray facing Mecca. Similarly, Chinese patient may refuse to take pain relief medicine, post operation considering it an impolite offer. In order to deal with these challenging situations, the nurse must have comprehensive understanding of the ethnic and cultural norms of culturally diverse people living in the society (Giger, 2016). In addition the, patients may fear using interpreters for breach of privacy and confidentiality of the information. It prevents the professionals from establishing the therapeutic relationship. The cost of using interpreters is high and is not always possible to recruit them in stressful environment. The indigenous Australians in remote areas and other ethnic minorities face language barrier commonly. They thus, lack access to health care facilities.  It also hinders the process of clinical handover and conveying of critical information (Espinosa et al. 2013). Cross-cultural training is the best way to promote effective communication in health care. It will improve the skills and attitudes of health care professionals to interact effectively with refugees, immigrant nurses and patients and other patients from culturally and linguistically diverse communities (Lee et al. 2015).

2.A focus group can be recruited in Melbourne hospital comprising of the doctors, nurses and the other health care staff to implement the solution of cross cultural communication skills. However, the focused group participants must have awareness of the ethical implications associated with the communication in diverse health care system. Ethics is an important parameter for health care providers as they deal with life and death of people. They are accountable for misdiagnosis, medical errors and misinterpretations in clinical care (Kourkouta and Papathanasiou 2014). Thus, ethical factors must be considered before implementing the cross-cultural communication system.  

Informed consent is the heart of any research process. It is the fundamental health behaviour. If the participants do not know that they are part of research, it may not serve the purpose. Other ethical implications arise due to breach of four principles that is autonomy, beneficence, non-maleficence and justice (Ganz et al. 2015). Non-maleficence is the obligation of not inflicting any intentional harm to the participants by the researcher. Due to language barrier, a health care provider may unintentionally harm a patient (Nursingmidwiferyboard.gov.au. 2017). Eliminating miscommunication between the conveyer and recipient reduces the gap and help to achieve the research aims and objectives. The same in cross-cultural nursing when practiced ensures beneficence of patients. Justice refers to ethical decision making. It involves equal participation of all the members of the focused group and respecting their opinions, rights, preferences and given equal opportunity to give ideas. The health care providers must also engage in making justice to the patients by respecting their cultural norms and beliefs and ensure safety. Right to autonomy of all research participants should be ensured. They must have autonomy to withdraw from the project anytime and their valuable contribution. Similarly in health care setting, they must have the health care providers must ensure patient’s autonomy in health care decisions (Nursingmidwiferyboard.gov.au. 2017).

Challenges to Implementing Effective Cross-Cultural Communication in Healthcare

The research project comprise of low risk as it deals with health care providers and targets people who can give consent and are all above 18 years old. The research project will be conducted in the Melbourne hospital itself in a safe environment. The focused group only involves in discussions and there is no scope of troubled spots.  A written consent will be given by the researcher to ensure the protection of privacy and confidentiality of the information collected during focused group discussion (Sellman 2016).  Thus, I think it will be helpful to successfully complete the ethics application form as there will be no breach of justice, autonomy, respect and confidentiality.

Conclusion

Cross-cultural communication is an effective tool to address the health issues of culturally diverse patients. It determines patient satisfaction and improvement in the health outcomes. It is a best practice to decrease the rate of medical errors. To avoid communication gap it is necessary to eliminate the cultural gap. By knowing the multilingual signs, bilingual words and phrases, pictograms and other customs of Indigenous patients, refugees and other immigrants, their needs can be identified rapidly. It will prevent delay in diagnosis and provide solutions in a proactive manner. As a ethics advisor the recommendation has been reviewed and  the ethical implications related to recruitment of focus group has been discussed. The implications has been related with the ethics application form.

References

Espinosa, M., Keller, H. and Westphal, N., 2013, June. Educational outcomes and effects on cross-cultural communication skills of an international experience for undergraduate STEM students through Michigan Technological University's Pavlis Institute for Global Technological Leadership. In Proc. of the 120th ASEE Annual Conference, Atlanta, GA (pp. 23-26).

Ganz, F.D., Wagner, N. and Toren, O., 2015. Nurse middle manager ethical dilemmas and moral distress. Nursing ethics, 22(1), pp.43-51.

Giger, J.N., 2016. Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.

Holland, K., 2017. Cultural awareness in nursing and health care: an introductory text. CRC Press.

Kourkouta, L. and Papathanasiou, I.V., 2014. Communication in nursing practice. Materia socio-medica, 26(1), p.65.

Lee, A.L., Mader, E.M. and Morley, C.P., 2015. Teaching Cross-Cultural Communication Skills Online. Family medicine, 47(4), pp.302-8.

Nursingmidwiferyboard.gov.au. 2017. Nursing and Midwifery Board of Australia - Professional standards. [online] Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 22 Aug. 2017].

 Professionalsaustralia.org.au., 2017. THE CASE FOR CHANGE Consequences and costs of failures in the translating and interpreting industry. [online] http://www.professionalsaustralia.org.au. Available at: http://www.professionalsaustralia.org.au/translators-interpreters/wp-content/uploads/sites/43/2015/03/The-Case-for-Change_EMAIL.pdf [Accessed 24 Aug. 2017].

Sellman, D., 2016. The practice of nursing research: getting ready for ‘ethics’ and the matter of character. Nursing inquiry, 23(1), pp.24-31.

Silverman, J., Kurtz, S. and Draper, J., 2016. Skills for communicating with patients. CRC Press.

Taylor, S.P., Nicolle, C. and Maguire, M., 2013. Cross-cultural communication barriers in health