Soapbox
Your say about nursing issues
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 040 - 040
Article Text
Culturally appropriate for all?
It would be a very uninformed nurse who has not yet heard the call that nursing has to become more appropriate to meet the needs of multicultural Australia. In fact, the rhetoric is beginning to be repeated so often as to be in danger of becoming clichéd and jargonistic.
The Australian health care system has been derived mainly from Britain and the United States of America. Hence, the standardised delivery of health care has been more appropriate for those who speak English and who behave according to Anglo-Australian ways. An example of the standardised approach under the guise of equity is the often heard claim that, 'We do not discriminate around here, we treat everyone the same'. However, the multicultural approach emphasises value in people's difference and requires the development of flexible processes of health care that can change to fit the needs of clients from different cultural backgrounds.
The early transcultural nursing literature called on nurses to become familiar with the values and customs of their diverse client groups, in order to provide culturally sensitive nursing care. However, this approach was unrealistic and unlikely to lead to successful care. How was a nurse expected to become familiar with many cultures in a way that made this new knowledge meaningful? Furthermore, the development of 'shopping list' descriptions can promote cultural stereotyping in which, for example, all Greeks are considered to think, feel and behave in a similar way.
The approach that requires the nurse to 'get the knowledge' in order to provide care maintains an outdated model of professionalism, in which the professional (in this case the nurse) is expected to hold the sale responsibility for the delivery of health care. Abetter approach which will enable nurses to provide effective health care when faced with situations of difference is required. This requires acceptance that individual practitioners and individual agencies may never be able to acquire all the expertise required to effectively help all of their different clients. Rather than load ourselves with impossible expectations, I suggest we learn how to work with others who have the language skills and cultural knowledge that we do not have. This approach would enable the negotiation of better care for individual clients and also community groups. For example, rather than trying to learn the health beliefs and practices of the Vietnamese in order to care for Vietnamese speaking clients, it would be more productive to work with a Vietnamese ethnic health worker or interpreter and negotiate care with the individual Vietnamese client. It might also be appropriate to work with a Vietnamese Community Association in planning the discharge care of the client. The focus then, is not on the nurse learning about the health beliefs and practices of the Vietnamese (although this will occur), but on learning how to use the resources that are available, in order to negotiate with a particular Vietnamese speaking client about their needs.
We know that nurses need to become culturally responsive. The discussion now needs to move along to focus on the needs of both education and practice. We need to consider what has to happen during nursing education so that nurses will feel more comfortable working with clients who speak a different language and who hold different cultural beliefs. This will also assist nurses to work in partnership with ethnic health workers, interpreters and ethnic community associations. We also need to consider what has to happen in health care agencies to ensure that the processes and resources are in place to enable these working partnerships to develop.
Jeff Fuller RN RPN BN MSc(PHC)
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