In today's multicultural society there are implications for the nurses and doctors who provide health care for that society. Patients whose culture and beliefs differ from those of the nurse are yet another challenge for the nurse in teaching stoma care.
Planned care must evolve from around the patient's culture and religious beliefs, and it must be determined whether their belief is an orthodox or a secular belief. Awareness and understanding of the multicultural world in which the nurse works and ways of knowing people in different frames of reference is challenging and nurses are beginning to recognize the values and beliefs and health practices of different cultures in order to provide culturally appropriate care that is relevant to the population (Black, 2000).
Nurses are beginning to recognize that, apart from the obvious fact that many patients from ethnic minorities have little or no command of the English language, religion and customs affect the ways in which this group of patients perceive their care. The environmental context in which individuals have been reared may influence health perceptions and health influences. Culture and ethnicity may influence one's physical development and exposure to health-compromising environments and conditions. Culture may also influence the family structure and how individuals respond to health and illness.
For nurses to provide culturally competent care - a complex integration of skills, knowledge and attitudes that cross cultural communication - they must demonstrate respect for others and promote the well-being of the patient. Although a comparatively small number of patients come from ethnic minority groups, a failure by nursing and medical staff to understand their special needs can lead to isolation of individuals on returning to their communities, and indeed they can become outcasts of that society. Smaje (1995) suggests that the contemporary ethnic character of Britain's population was forged in the nineteenth and twentieth centuries, largely as a result of government policies. With this wide ethnic diversity now seen in Britain, it brings to the forefront the need for the NHS to respond appropriately, with cultural and clinical competence, in the provision of care for these groups which until now have occupied a marginal position when it comes to healthcare policy and delivery.
Careful consideration should be given to the influence of cultural differences in stoma management before a teaching plan is designed. Some cultural practices are harmless and can be accepted or ignored, some are harmful to health and the nurse should explain her reservations about the practice. Ultimately the patient and family reserve the right to carry out the practice if, after due explanation, the family feel that it should be continued once at home.
If the patient speaks no English a translator should be used and it is entirely inappropriate to use the ward domestic staff because she or he speaks the same language or dialect. A medical translator should be found who is acceptable to the patient and family. Most hospitals and hospital switchboards keep a list of approved translators from within the hospital or from approved translating services. Occasionally, if the translator is from a non-approved source, the translation of what the patient needs to know may not be what the patient receives. It may be that the translator feels that what the patient has to be told is not suitable and therefore the patient is shocked when unexpected surgery and a stoma are the eventual outcome. It would be impossible for healthcare workers to expect to understand fully all the cultural and religious needs of the ethnic communities with which they come into contact, but they should at least be aware of the ethnic mix of the local community in which they work.
Limited translated leaflets for Pujabi- and Gujurati-speaking patients who are to have a stoma are available from the British Colostomy Association and further information on multicultural aspects in stoma care can be found in Black (2000).
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