Cultural Difference in Nursing

This assignment will be based on a patient from a different culture to my own and how the culture difference had a significant impact on the ability to communicate or engage with the patient. During this assignment the patient will be referred as Mr Y as confidentiality of the patient must be maintained in accordance to the Nursing and Midwifery Council guidelines (NMC, 2010).
In the time of my placement in Outpatient Department in one London Hospital, Mr Y a 63 year old patient, originally from Pakistan had a follow-up appointment in urology clinic due to bladder malfunction. Prior to Mr Y’s appointment he had to do two tests, a flow-rate and a bladder scan which analyses how good a patient empties the bladder. However due to Mr Y traditional Islamic beliefs and culture, he refused the bladder scan to be implemented by a female nurse and to be seen or examined by a female doctor.
As a healthcare professional is essential to acknowledge and recognise cultural differences and needs of a patient that comes into our care as everyone has a culture which is influenced by many factors, such as race, gender, religion, ethnicity, sexual orientation and life experience. Furthermore is also important that healthcare professionals are aware of their own set of values, beliefs and world views in order to provide appropriate care. Schultz and Videbeck (2009) shared the same view that nurses need to maintain their own cultural awareness on a daily basis with all patients because of the multilevel nature of culture orientation.
In Mr Y case his cultural needs in relation to communication and engagement were acknowledge, when Mr Y booked at the clinic reception he was informed that there will be some test that would have to be done prior to his appointment with the doctor. Unfortunately he wasn’t informed that it would be performed by a female nurse nor that he might be seeing by a female doctor, notwithstanding once Mr Y was ready, under the supervision of my mentor I approached him to inform him that I was going to perform the scan and that it was his turn, he instantly became anxious and slightly stressed with the information I had given him.
As I noticed that he was very uncomfortable and nervous, I asked him if there was any concern that he wanted to address with me or the doctor he then disclosed that he was not happy or comfortable with me doing the scan as it wasn’t appropriate and respectful in his culture, I instantaneously had to inform my mentor as I needed to assure her of the situation I was encountered with and what I intended to do in order to help the patient. Culture relates to moral values, beliefs, social norms and accepted behaviour, individuals in any culture are expected to adopt and comply with that culture’s rules. In accordance to that I forthwith asked him what religion he practices and once he said he was a Muslim, I somehow understood and sympathised with him and comprehended his anxiousness, because I had a slightly understanding of that culture. I knew that some Muslim culture, for some if its practised strictly they consider that it’s not permitted to touch an adult person of opposite sex other than one’s spouse, meaning that some Muslim men or women may refuse to be examined by the opposite member of medical staff.
Abdullah (1995) claimed “that caring involves the intellectual analytical ability of the nurse to relate relevant and cultural knowledge in the delivery of effective care. Moreover he claimed that each nurse has to think about her or his interactions with the patients from all kinds of cultures and backgrounds and has a responsibility to learn about the patient’s culture.” I therefore informed him that there wasn’t any male nurse or healthcare assistance, so the test had to be performed by the doctor who was a male doctor but there might be a delay as there were two doctors with one of them being a female doctor and I had to inform the doctors and get their approval. When a nurse views the patient’s problems from their cultural aspect, it shows empathy therefore allowing the patient to know their cultural beliefs are respected and considered in their care.
Once I informed the doctors, who were surprised by the patients wishes, that the patient wasn’t content with me doing the scan and that he considerably preferred a male to do it due to his cultural beliefs, the doctor agreed on performing the scan but advised me to inform the patient that he had to be seeing at the end of the clinic as it would delay the clinic otherwise. I consequently notified Mr Y of the decision and apologetically informed him that he would be the last on the doctor’s list, as in another way it would put the clinic behind the schedule time and perhaps cause other consequences to other patients who were waiting to see the doctors.
Immediately after that was agreed, the clinic proceeded until it was Mr Y time to see the doctor, the bladder scan and the consultation was implemented by the male doctor as Mr Y wished, on his exit he approached me to thank me for understanding and for being helpful. On the other hand if Mr Y cultural differences were not taken into account or ignored, it could have been said that not only his human rights were breached but also my duty of care was immoral and not autonomous (International Council of Nurses(ICN),2000). As mentioned earlier the patient was very content as after his consultation with the doctor he came back to thank me for taking his cultural needs in to consideration, therefore the consequences were positive for the patient, and also for the doctor and myself because aside from respecting his religious views we accepted and treated him as an individual in confidential way.
The Code of Professional Conduct (NMC, 2010) claims that nurses needs to act in way where it maintains the trust and confidence of the general public has in the profession.
While the outcome was satisfactory for the patient and the rest of the team, in the beginning of the situation I felt slightly uncomfortable and surprised, although I had an inconsiderable understanding of Mr Y religious belief, I’d never come across a situation where a male Muslim was refusing treating from a female healthcare professional. Furthermore due to me being a female I felt like he wouldn’t want me to perhaps communicate or engage effectively with him as I would with any other patients, which for me was what was bad about the experience. As nurses we have the role to help patients to calm their anxiousness or worries and I felt I couldn’t do that with Mr Y due to his beliefs, nevertheless it is also my role to be advocate to protect and respect his rights. Over and above that, the positive aspect of the experience was that although I felt uneasy at first, I made the patient feel like his request was respected and I felt that the communication between the doctors and I was appropriate and considerate, which resulted in a smooth running of the clinic without cause any stress or concern to the other patient in the waiting room.
Looking back at the whole scenario, I’ve learned and it has made me realise that in nursing there is so much that nurses have to consider, not just the health of the patient but his/her moral and cultural beliefs and how essential duty of care is whether in a ward, where you care for a patient for weeks or months but also in outpatient department where a patient might just come as patient for a simple consultation. In accordance to the cultural dimensions of communication and engagement, when Mr Y clarified his reasons for refusing a scan, I instantly thought that he wouldn’t want communicate with me or wanting me in the consulting room due his beliefs but I was mistaken as he later came back to me to show his gratitude and appreciation, which showed me that possibly I need to learn more about cultures.
The broader issues arising from this situation is that although healthcare professionals are aware of the increase of ethnically diverse population in the UK, they perhaps don’t have much knowledge of their patients’ cultural beliefs and values. And that as nurses strive to provide culturally sensitive care, they must recognise how the patients’ and their perceptions are similar as well as different.
In conclusion the role of any healthcare professional, registered nurses or students nurses is to help the patient to meet her/his specific health goals and this might require exploring the patients’ view and attempting to understand the meaning behind a particular request, as well as the patients’ overall goals for treatment. Furthermore there is no right approach to all cultures or all individuals with similar cultural background, each patient and each situation is unique and requires individual assessment and planning.

References
Abdullah, S.N, (1995) Towards an individualised client’s care: implications for education. The transcultural approach. Journal of Advanced Nursing 22:715-720.

International Council of Nurses (2000) ICN code for nurses: Ethical concepts applied to nursing. Geneva: Imprimeries Populaires.

Nursing and Midwifery Council (NMC) (2008) Confidentiality. Nursing and Midwifery Council.[online] Available from: http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Confidentiality/ [accessed 28/03/12]

Nursing and Midwifery Council (NMC) (2008) Code of Professional Conduct-standards for conduct performance and ethics, London: NMC.

Schultz, M. Judith and Videbeck L. Videbeck (2009) Lippincott’s Manual of Psychiatric Nursing Care Plans. 8th edition, Philadelphia, Lippincott Williams & Wilkins.