International Journal of Nursing Practice 2000; 6: 146152
INTRODUCTIONAny research project must have as a basis valid reasons forits instigation.The research should be useful in improvingcurrent practices in changing contexts, to introduce newconcepts or to evaluate the effectiveness of current prac-tices or, in fact, to validate the existence of current prac-tices.The research questions for this Masters of Educationmajor thesis, which were based on the premise that cul-turally and linguistically diverse (CLD) registered nurseshave culturally based nursing knowledge, skills and exper-tise, were as follows:1. What kinds of culturally based nursing knowledge,skills and expertise do CLD nurses possess?
2. What contribution or influence or change can thisinformation make to nursing education and practice inAustralia?
The significance of the study is clear: that is, the resultscould modify the way nurses are educated. Such modifi-cations involve discovering what changes need to be madeand how the cultural attributes that CLD nurses bring toAustralia can be utilized to improve nursing education andpractice for Australias multicultural population. Thewider implication of this study includes an understand-ing of what CLD patients may expect regarding nursingcare, and how changes in nursing education and practicethat take into consideration CLD nurses culturally basednursing knowledge, skills and expertise may overcomeperceived shortfalls in these expectations.
The target group for this research project was overseas-qualified registered nurses from non-English-speakingbackgrounds. All nurses who participated in migrantnurses pre-registration programs in Melbourne from
R E S E A R C H P A P E R
Recommendations for culturally sensitive nursing care
Patricia Josipovic RN; DipAppSc(NsgEd), BAppSc(Nsg), MEdCourse Coordinator, School of Nursing, Deakin University, Burwood,Victoria, Australia
Accepted for publication June 1999
Patricia Josipovic. International Journal of Nursing Practice 2000; 6: 146152Recommendations for culturally sensitive nursing care
Australias health care clientele reflects the diversity of this multicultural society. Patients and health care professionalshave expectations of health care which may not be met to their satisfaction or needs. The perceived inadequacies of andincreased demands on the Australian health care system are reflected in the literature and by active political lobbying.Thus, there is an urgent need to investigate how the health care system can be improved and how recommendations fromresearch can be put into place. One mechanism that may provide some of the changes required is to use the skills, ex-perience and qualifications of culturally and linguistically diverse nurses. This paper, which is based on a descriptive ethnographic research project, will provide insight for utilizing this valuable and available resource, and how nursing education curricula can be modified to adequately incorporate transcultural nursing practices, so that nurses can meetthe challenges of caring for Australias multicultural population.
Correspondence: Patricia Josipovic, 16 Canterbury Street, Yarraville,Victoria 3013, Australia. Fax: +61 3 9314 8483; Email:email@example.com
Culturally sensitive nursing care 147
1991 to 1993 were surveyed. The questionnaire wasdeveloped on themes explored in the literature review.
Themes involving nursing practice included:
Pain and nursing care Touch and nursing care Cleanliness/hygiene and nursing care Death and nursing care Communication skills and nursing care Nursing education policies Political influences
Five educational institutions were involved and 150questionnaires were sent out. Of these, 49 nurses re-sponded and from these, 16 agreed to be interviewed.Theinterview utilized trigger questions from the literatureand issues raised from responses to the questionnaire.Sample trigger questions are:
Could you describe the status of nursing in the countryyou practised, other than in Australia?
Can you tell me about some customs or traditions [ofcultures other than Australia] with regard to touch,cleanliness, diet, death and so on?
Are there any differences that you noticed in nursingpractice, education/training, role of the family etc.,between your country and Australia?The in-depth interviews and field notes were tran-
scribed.The findings from the questionnaire and interviewdata were analysed for emerging themes that linked thequestionnaire and interview data with the major cat-egories identified from the literature review. Discussion ofthis thematic analysis will now follow. Recommendationsmade in the discussion are a result of the data collectedfrom the study participants and the researchers ownknowledge and experience.
LANGUAGE ISSUESMajor inhibiting factors to effective nursing care and internal com-
munication within a profession is a lack of information and skills
in working cross culturally.1
The data collected revealed certain distinct suggestionsfrom the respondents, based on their own experiences,with regard to cultural topics that should be included innursing courses and practice in order to provide cultur-ally sensitive nursing care, including learning another language. Just as vital, the respondents believed, was the congruency of languages and ethnic background ofpatients and nurses, where possible, as there are a lot ofcultural issues inherent in language.
Respondents recommendations included:
the introduction of elective subjects such as LanguagesOther than English (LOTE) in nursing educational programs;
giving award exemptions or credits for nursing stu-dents who speak fluently a language other than English;
the employment of bilingual nurses in health care settings;
encouraging institutions to give financial remuneration,or promotional/seniority positions for fluency in lan-guages in addition to English;
the formation of a data bank of languages spoken bynurses and a rostering system that promotes optimaluse of these specialist nurses; and
developing a system of identification of nurses who arefluent in languages other than English, indicating lan-guages spoken for easier recognition by patients andother nurses.These recommendations could imply that, in some
instances, the services of qualified interpreters, which canbe a scarce commodity, could be utilized more effectivelyif bilingual nurses can share this workload.
CULTURAL UNDERSTANDINGImproving understanding of different cultures was anothersuggestion that arose from the data.The implication of thisfinding is that,with this knowledge,nurses will have a muchbetter understanding of patient behaviour and be able toimplement culturally appropriate nursing care. It is notsuggested that nurses should know everything there is toknow about each cultural group that they may come in con-tact with; this is impractical from a curriculum perspective,as well as an unnecessary knowledge overload. Rather, thefollowing recommendations should be implemented:
Cultural awareness and cultural sensitivity should betaught throughout nursing curricula.
Experiences should be shared between CLD nurses andother nurses in a formal and informal manner in theclassroom, such as with guest speakers or in profes-sional staff development sessions.
There needs to be official recognition of these nursingcultural skills, such as by outlining them as part of thespecific duties of a position.
CLD nurses experiences should be published. Australian nursing research projects should be insti-
gated to explore solutions to perceived problem areas,such as cultural differences in health and illness prac-tices, and the use of health care services.
148 P. Josipovic
This should be done to increase the pool of informa-tion, to change perceptions and to aid in the removal ofstereotypes and racial barriers. The recommendation for the instigation of research could also assist in develop-ing knowledge and subsequent theories and to validatefindings: this would be essential to promoting multicul-tural health care as a valid and credible field of study.According to the Royal College of Nursing Australia,research these days is becoming the backbone of many tertiary institutions, and increasingly so in the field ofnursing, both at the tertiary level and health care setting.2
Targeting issues that have bearing on a large proportion ofpatients would appear to be a very forward-looking strat-egy, which could be at the forefront of changing healthcare policies from a practice point of view. This recom-mendation could also put the nursing profession at theforefront of such an integral field of research.
Recent pioneering developments in nursing educationthat incorporate other health belief models, such as thosecited by Tan3 and Boyle and Andrews,4 have seen the intro-duction of complementary therapies in nursing prac-tice. One university in Victoria is now offering tertiary-based complementary therapy courses, which include aromatherapy, acupuncture and therapeutic massage. TheNurses Board of Victoria has also established guidelines forthe use of such therapies in nursing practice.This indicatesthat the Board generally accepts this new avenue of nursingpractice in recognition of the increasing interest shown in complementary or alternative therapies by the generalcommunityand by a significant number of nurses.5 Atthe time of writing this article, the author acknowledgesthat courses in complementary therapies are emerging inother health and nursing faculties across Australia.
Other nursing issues requiring cultural understandingthat have been identified in the literature and the data are:
gender, in relation to the acceptance of differentgenders i