CULTURAL CONSIDERATIONS WHEN ▪ Societal level: It is important to all aspect

PATIENT SPEAKS DIFFERENT LANGUAGE of human interaction because it often

related to the political goals.
CULTURE
UNDERSTANDING THE NEED FOR
CULTURALLY LINGUISTIC CARE ▪ Characteristics shared by community
▪ Distinguish by other communities
▪ United States Census - 26% of the
▪ Learn by other people
population speaks English at home.
▪ Different communities have some
▪ 36 million American speakers of a foreign
common or different characteristics
language speak Spanish
▪ In culture we mostly include eminent
▪ 2nd largest - speaks Chinese
characteristics that exist rare in others
▪ Variety of Asian languages: Tagalog,
Vietnamese, and Korean, RELATIONSHIP BETWEEN LANGUAGE AND
▪ Proficiency has significantly increased CULTURE
over the last 20 years
▪ Structure of language determines the way
▪ 60% of this population is Spanish
the language that a speaker of that
speaking
language view the language of world.
Language ▪ Culture is reflected in language cultural
requirement do not determine structure of
▪ mean of communication
language but influence how it used.
▪ -Primary vehicle of communication
EFFECT OF CULTURE ON LANGUAGE
Through Language:
▪ a Culture influences language acquisition
▪ we establish and maintain the relationship
from the very early stage through the
▪ we transmit our culture
entire developmental process.
▪ we categories the world
▪ culture influences all aspects of language.
Language separates us from other species of ▪ it is through use of language that an
animals. individual is transformed into agent of
culture.
This single human trait makes us unique from ▪ Culture has powerful influence on verbal
animals. and nonverbal encoding and decoding
We cannot be human without a language processes.
▪ Culture affects not only language
THREE MAIN FUNCTION OF LANGUAGE lexicons, but also the function and / or
▪ Cultural perspective: it is primary means pragmatics.
of persevering the culture and medium of ▪ Change in society may produce
transmitting the culture of the new corresponding linguistic changes.
generations.
▪ It helps establish and preserve
community by linking individuals into
communities of shared identity.
LANGUAGE DIFFERENCES ACROSS gender, and/or when their cultural beliefs
CULTURES and attitudes are not considered.
Culture and Lexicons FIVE PRINCIPAL ETHICAL NORMS FOR
CROSS-LINGUISTIC NURSING:
a. Self-Other Referents
- in U.S. the use of "I" "we" is prevalent, 1. Respect for the patient as a unique
but in Japan there are cultural rules person;
governing how to refer self and other. 2. Respect for the patient's right to self-
It is dependent largely on the status determination;
relationship between and other 3. Respect for patient privacy and
person. confidentiality;
b. This reflects importance of status and 4. Respect for one's own competence,
group differentiation in Japan. judgement and action;
5. Responsibility to promote action better to
LANGUAGE BARRIERS THE NURSES
meet the needs of patients, families, and
SHOULD BE:
groups
▪ a Communicating effectively with
LANGUAGE DIVERSITY
patients, to be able to listen, observe, and
understand the beliefs and needs of their Communication gap that is created by differences
patients and to use culturally relevant in following patient's aspects:
concepts when communicating with them.
- linguistic style
▪ Culturally and Linguistically Appropriate
- dialect
Services in Health Care (CLAS)
- literacy
mandated to "offer language assistance
- and non-verbal communication
to individuals who have limited English
proficiency and/or other communication Cross-linguistic communication should
needs, at no cost to them, to facilitate consider the cultural context
timely access to all health care and
services.” Low context
▪ Language enables us to establish a ▪ use of many words to convey a particular
rapport with our patients, communicate message.
our ideas, and negotiate our plan of care. ▪ includes English, German, and French
"It is the primary way nurses
communicate caring." High context
▪ "Linguistic barriers between nurses and ▪ use fewer words and meaning is found
patients can threaten quality nursing care between the lines as more attention is
by perpetuating stereotypes and fostering paid to the nonverbal or cultural cues
the delivery of care based on transmitted through body language.
misinformation and assumptions." ▪ includes Native American languages and
▪ The level of stress is increased as Chinese
patients feel alienated or marginalized
because of cultural differences based on
skin color, language, physical ability,
Linguistic style Barriers to Effective Communication
▪ refers to the way in which words are used ▪ Physical barriers
to send messages ▪ Perceptual barriers
▪ includes tone of voice, rate of speed, and ▪ Emotional barriers
degree of loudness. ▪ Cultural barriers
▪ reflects the speaker's vocabulary pace, ▪ Language barriers
pitch, and intonation choices. ▪ Gender barriers
▪ Interpersonal barriers
Health literacy
Barriers to communication can adversely
▪ is influenced by a variety of cultural
affect patient:
factors, such is ethnic background
geographical origin, and gender refers to ▪ access to healthcare
the ability of patients to understand their ▪ ability to give informed consent
health information. ▪ medical and nursing diagnosis
▪ assess reading capacity of patients from ▪ health education
both English-speaking and linguistically ▪ healthcare outcome
diverse backgrounds.
Three Important strategies the nurse can use
Language Barriers - Refer to the challenges with patients who speak esl:
faced by people or groups speaking different
1. Listen actively while paying particular
languages and dialects. It also includes
attention to the patient's use pf silence
misunderstanding and misinterpretations that
throughout the conversation.
come from a lack of clarify of thought and speech
2. The nurse should seek to clarify
Types of Language Barriers nonverbal communication to avoid
misinterpretation
1. Language difference, where a person
3. The nurse should remember to strive to
interacts with someone speaking a
convey patience and caring through
different speaking a different native
nonverbal measures
language
2. Dialects and accent, where two people (includes moving about in anon hurried
may share a common language but they manner, facing the patient when
speak it differently (based on a particular) communicating, touching when culturally
3. Lack of clear speech, where people speak acceptable and smiling)
too soft or too fast; either way, it's unclear
Methods that healthcare facilities can utilize to
what they’re saying
provide language access to patients:
4. Use of technical words or jargon, where
someone communicates using specific ▪ Having a bilingual clinical staff
terms that are highly technical and ▪ Telephone interpreting services
subject-specific ▪ Translators and translation software for
5. Words of choice, where someone uses written materials
words with 2 meanings or say it ▪ Language classes for staff -Video medical
sarcastically that may be misinterpreted interpreting services
by the listener ▪ On-site medical interpreters
 ▪ Interpreters should be knowledgeable of ▪ Some myths about language diversity
medical terminology and procedures as influences nurses attitudes about caring
well as patient's rights in a clinical setting. for linguistically diverse patients
▪ Age and gender are considered when ▪ The person selected to assist the nurse
sensitive or personal issues related to by translating and interpreting for the
sexuality are discussed. patient should ideally be a trained medical
interpreter.
Nurse should maintain eye contact, direct
▪ Using family members, especially
questions to the patient, avoid using medical
children, may violate patients
jargon or idiomatic expressions, and observe the
confidentiality and privacy rights
patient for nonverbal cues.
▪ Strategies for caring for linguistically
When communicating with LEP patients: diverse patient include actively listening,
seeking clarification, using an appropriate
▪ give and seek feedback often interpreter, and paying attention to
▪ repeat key phrases nonverbal communication
▪ summarize important points ▪ it is important to document the session
Important Points and its outcome with the interpreter
(Smith, 2007)
▪ Nearly 65 millions, or 21.5%, of the U.S
populations speaks a language other than Working with an interpreter (Andrews & Boyle)
English as a primary language ▪ Meet with the interpreter beforehand to
▪ CLAS standards are national guidelines describe the nature of the translation
and mandates that compel hospitals and meeting with the patient
healthcare providers to provide culturally ▪ Plan to utilize more time for the session
linguistic care. with the patient and interpreter
▪ Language diversity includes ESL issues ▪ The conversation should always be
as well as linguistic style, dialect, literacy, focused on the patient
and nonverbal communication patterns. ▪ Speak only a sentence or two before
▪ Literacy refers to the ability to read and allowing the interpreter to translate
write. ▪ Use simple language; avoid medical
▪ Linguistic styles refer to the way in which jargon
words are exchanged. This includes tone ▪ Be attentive to nonverbal clues by the
of voice, rate of speed, and degree of patient
loudness.
▪ Linguistic style does not reflect an When there is no interpreter:
individuals intelligence or ability
▪ Be polite and formal
▪ Language barriers can adversely affect
▪ Greet the patient using their last name;
patient's access to healthcare, ability to
offer a handshake or nod. Smile
give informed consent, medical and
▪ Speak in a low, moderate voice
nursing diagnosis, health education, and
▪ The nurse should always identify himself
healthcare outcomes.
or herself by gesturing if needed and
stating, "I am your nurse"
Attempt to use any words you know in the Hospice - a type of health care that focuses on
patient's language the palliation of a terminally ill patient's pain and
symptoms and attending to their emotional and
▪ Use simple words spiritual needs at the end of life.
▪ Pantomime words and simple actions
while verbalizing them Hospice care prioritizes comfort and quality of life
by reducing pain and suffering.
Validate the patient's understanding
Life support - the treatments and techniques
▪ Obtain phrase books from a library or
performed in an emergency in order to support life
bookstore
after the failure of one or more vital organs.
▪ Seek age and gender appropriate
individuals who speak the patient's Palliative Care - specialized medical care for
language and dialect to assist you. people living with a serious illness. This type of
care is focused on providing relief from the
symptoms and stress of the illness.

CULTURAL CONSIDERATIONS WHEN The goal is to improve quality of life for both
CARING FOR THE PATIENT WHO IS the patient and the family.
TERMINALLY ILL
Stigma - happens when a person defines
At the end of life nurses are the largest and most someone by their illness rather than who they are
likely group of professionals to play a critical role as an individual. For example, they might be
in ensuring that the wishes and goal of patients labelled psychotic' rather than 'a person
are met. experiencing psychosis'

Key terms Terminal Illness - a disease or condition which

can't be cured and is likely to lead to someone's
Acculturation death. It's sometimes called a life-limiting illness.
• assimilation to a different culture, typically Nurses also tried to help patients make sense of
the dominant one. their suffering, and find meaning in their lives and
• the transfer of values and customs from the dying experience (Hung-La Wu &
one group to another. Volker,2009).
Advance directive - legal documents that allow Nurses can begin to care for the terminally ill from
you to spell out your decisions about end of life evidence- based perspective:
care ahead of time.
• reflecting on their own attitude and beliefs
Culture - broad term that encompasses, beliefs, • educating themselves through in-service
values, norms, behaviors, and over all can be or continuing education workshops and
understood as our "way of being.' conferences that enable them to
determine what actions are needed to
Espirituista - popular belief that good and evil assist patients and families in managing
spirits can affect health, luck and other aspects of the dying process.
human life. • should strive to assist patients in finding
personal meaning in the dying and death
experiences.
 • maintaining one's own spiritual well- DAP-R measures death attitude on five scales
being, to be effective in delivering
culturally relevant care. 1. Fear of death
2. Death avoidance
3. Approach acceptance
4. Escape acceptance
The experience of dying is compound by the 5. Neutral acceptance
psychological trauma that results from attitudinal
barriers that are imposed by society because of THE ROLE OF NURSES
the nature of patient's illness.
Nurses will need to become knowledgeable about
The emotional pain, grief and fear associated with the important cultural aspects of care to address.
dying occurs from the time of the suspected
diagnosis, but is made more difficult because of "patient-centered approach," that goes beyond
the stigma that is still associated with the particular having advance directives, which direct patient's
disease. (Zukoski & Thorburn, 2009). treatment during the end of life. Shalev (2010)

IMPORTANT POINTS Nurses can facilitate such encounters by "creating

an open, safe, and supportive space in which the
Caring for patients who are terminally ill requires conversation can take place' (Shalev,
nurses to first confront their own beliefs and 2010,p.143).
attitudes concerning death and dying.
Attentive listening to enable the patient's voice to
Traditional and ethical goals of nursing may differ be heard is a critical element of this process.
from those of the terminally ill patient.
The nurse will need to assess the patient's
Anxiety fear, and depression often accompany the psychological, cultural, spiritual, and religious
death and dying experience views when caring for terminally ill patients.

Differences exist between culturally diverse The nurse should utilize a variety of resources to
groups in their attitudes toward advance assist in providing culturally competent care to
directives, life support, disclosure of diagnosis, patients who have terminal illnesses.
and the designation of the decision maker.
Negative attitudes further complicate a terminal
A variety of health practices and rituals related to illness causing additional psychological stress.
death and dying are found among culturally
diverse groups. When caring for patient with terminal illness it is
important for the nurse to remain sensitive,
ATTITUDINAL BARRIERS & DEATH & DYING supportive and non-judgemental.

Different attitudes to death and dying "interaction between the RN and the patient
occurs within the context of the values and beliefs
• Positive attitudes include three of the patient and the nurse" (ANA,2010).
components of death acceptance
• Negative attitudes embody death, fear The nurse's own cultural values, attitudes, and
and escape beliefs about death and dying often set the tone
for assisting patients during this significant period
in their lives (Braun, Gordon and Uziely 2010)
ANA encourages nurses to be NURSING SET OF GOALS FOR PATIENTS
WHO ARE TERMINALLY ILL:
"mindful of the patient's cultural and spiritual
beliefs and to advocate for them without personal Palliative care - prevent and relieve suffering and
bias. to support the best quality of life for patients and
their families regardless of their stage of disease
Nurses need to have an awareness of their own or need for other therapy (National Consensus
attitudes and beliefs about terminal illness. And Project, 2007)
the process of death and dying.
"until nurses learn to cope with the specter of
CULTURAL VARIATIONS & BARRIERS death, they will be inclined to put a distance
between themselves and the dying (Hurtig &
Because there are such wide variations in Stewin, 1990)
preferences around death and dying experiences,
nurses must utilize a careful cultural assessment Hospice
of their terminally ill patients and include their
significant others in the process. 3 subthemes:

Gathering information that is specific and relevant A. holistic and meaningful care through
to the patient is the best way to ensure that the close relationships
patient's desired outcomes are achieved. B. confronting and managing negative
beliefs about hospice
Advance directive, life support, disclosure and C. managing the dying process
communication of diagnosis and prognosis, and
designation of primary decision makers. CULTURAL FACTORS & SPIRITUALITY

Nurses can begin the process of planning end of "Care at the end of life should recognize, assess
life care for culturally diverse groups by first and address the psychological, social,
expanding their perspective about what culture spiritual/religious issues and cultural taboos
means. realizing that different cultures may require
significantly different approaches"
Acknowledging barriers to communication (AAFP,2008;Gibson,2006).
between patients and providers is the first step in
finding ways to resolve issue in interacting. "Sensitive and appropriate spiritual care plan to
promote adequate coping for patients, families,
Nurses not make assumptions or predictions and significant others. Yet, while patients with life-
about the care needs of individuals based on their threatening illnesses believe that psycho-spiritual
knowledge of a particular cultural group. support during a terminal illness is critical, it is
often overlooked by many health care providers.
Nurses have both the privilege and responsibility (Searight & Gafford, 2005)
of ensuring that the final goals and wishes of the
patient are met. Priests, ministers, rabbis, lay ministers,
espirituista, and others are among the many
religious leaders with whom a patient may wish to
confer.