HLTHIR403C Work Effectively With Culturally Diverse Clients and Co-workers

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ork Effectively With Culturally Diverse Clients and Co-workers
Workbook
Assessment Task 1
Student Name: _________________________________________________
Group:________________________________________________________
Date: _________________________________________________________
Mark Achieved: /70
Acknowledgements:
The following scenarios and activities in this Workbook have been adopted and modified from the HLTHIR403C ‘Work Effectively with Culturally Diverse Clients and Co-Workers’, Learning Guide, developed by the Community Services and Health Diploma of Nursing Team at TAFE SA 2008.
Activities: 1.2, 1.3, 1.5, 1.6, 1.7, 2.1 – 2.4, 3.1, 3.2, 4.1, 4.2
Scenarios: 1 – 3
ASSESSMENT TASK 1 : 70 %
HLTHIR403C Work effectively with culturally diverse clients and co workers
The activities in this Workbook are to be completed during class time.
TOPIC 1: CULTURALLY AWARE WORK PRACTICES
Activity 1.1:
Pre Unit Delivery Student Self Assessment Exercise
Key to completing columns 1, 2 or 3:
1 = I feel quite confident that I can always do this
2 = I might sometimes need some help
3 = I have no experience in this area
NOTE: Students can draw on work experiences, or if they have not worked, draw on school experiences.

Apply an awareness of culture as a factor in all human behaviour
Can you/do you know how to? How well can you do this? List one example of how you might do this
1 2 3
Work in a culturally appropriate manner.

Work in a way which creates a culturally and psychologically safe environment for all persons.
Review and modify work practices in consultation with persons from diverse cultural backgrounds.
Contribute to the development of relationships based on cultural diversity
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Demonstrate respect for cultural diversity in all communication and interactions with clients, colleagues and customers.
Use specific strategies to eliminate bias and discrimination in dealing with clients and co-workers
Communicate effectively with culturally diverse persons
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Demonstrate respect for cultural diversity in all communications with clients, their families, staff, customers and others.
Constructively use communication to develop and maintain effective relationships, mutual trust and confidence.
Where language barriers exist, efforts are made to communicate in the most effective way possible.

Seek assistance from interpreters or other persons as required.

Resolve cross cultural misunderstandings
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Identify issues which cause conflict.

Consider cultural differences if difficulties or misunderstanding occur.

Effort is made to sensitively resolve differences, taking into account cultural differences.
Difficulties are addressed with appropriate people and assistance sought when required.
Activity 1.2 5 MARKS
Self-reflection
Take 5-8 minutes to reflect on your own ‘culture’. What do you think best describes it? Write down your thoughts so that you can compare them with the definitions a bit later in this topic.
……………..hindu …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
Activity 1.3 3 MARKS
Self-reflection
Think about some of the values and beliefs that you have inherited from your parents. They might include religion, work ethic, and respect for others or how to raise children.
How do these values and beliefs influence how you live your life?
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Activity 1.4: 5 MARKS
Range of cultural diversity in your work environment
Spend some time thinking about the cultural differences listed below and how each of the areas of difference effects what happens in your day-to-day work environment in relation to co-workers and clients. Record your answers in the table below.
You might include some of the following in your answers:
• Which staff are rostered on particular days. This might be to allow for people’s religious obligations, or to ensure a good balance of staff with particular language difficulties.
• Timing of peoples’ holidays to coincide with important religious or other celebrations.
• Timing of co-workers’ breaks to allow for prayer times.
• The need for understanding when co-workers are away from work because of their need to meet cultural or family obligations.
• The type of food served in the staff canteen.
• The inability of some workers to perform certain tasks because of cultural considerations. For example not handling food derived from ingredients which are culturally forbidden.
• The need to communicate with clients in a way which does not offend their cultural sensitivities.
• Different special requests from clients such as choice of food, style of room etc
• The need for patience in communicating with co-workers and clients who speak different languages.
• The way you talk to clients and co-workers.
• The way you react to your supervisor and the way your supervisor reacts to you.
Cultural Differences How does this difference effect what happens in your day-to-day work environment in relation to co-workers and clients?
Languages

Religious and other beliefs

Beliefs about health and wellbeing

Attitudes to family

Attitudes to work

Roles of individuals in society

Food

Holidays and celebrations

The way people communicate with one another

Activity 1.5: 3 MARKS
Functions of values – example
Think of and discuss one example of the function of values that has been allocated to your group. Write your example below.
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Activity 1.6 5 MARKS
Cultural Clash
Below is a student nurse’s experience of cultural diversity. After you have read the extract discuss the questions and answers with your group. Write your answers below.
Giancarlo Dilettoso had been a patient in the cardiac unit for five days. During that time he and his family had upset most of the nursing staff and some of the medical staff as well. Giancarlo never had less than six visitors at one time and frequently the number exceeded ten. He looked exhausted and other patients were complaining. Any approach to the family always ended in confrontation.
Mary, a Division 2 Nurse, came on duty at the beginning of visiting hours. She immediately assessed the situation and approached Giancarlo and his family. Mary calmly and reassuringly informed the family that they were wonderful to support Giancarlo so well. She acknowledged how difficult it was for them to visit several times a day and she knew how proud Giancarlo was to be a member of such a loyal family. Mary then told them that because of the nature of the ward, cardiac care patients had to be kept quiet and free of anxiety at all times. That included Giancarlo. All patients needed their rest and Mary suggested that just until Giancarlo was a bit better, only two relatives visit at one time.
The family responded positively, Giancarlo and the other patients got some rest and Mary was viewed as a magician by her co-workers.
• What did Mary do that differed from previous approaches?
• Do you think the fact that Mary is of Italian background had any bearing on the outcome?
• Have you any personal experience of advantage because you had first-hand knowledge of a particular culture?
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Activity 1.7: 5 MARKS
Relevance of culture to nursing
Trevor is a student nurse completing his acute medical clinical placement. Mrs Xian, a Chinese Australia has just been assigned to him. Her diagnosis is undiagnosed abdominal pain and she is experiencing rectal bleeding. Trevor encourages Mrs Xian to eat her breakfast but his request is refused. When Trevor attempts to discuss the importance of nutrition Mrs Xian patiently explains that she is not stupid and knows that she must eat. However, because of her problem, yin and yang must be carefully balanced and the hospital diet does not accommodate this.
Trevor learns more about the concept of yin and yang in relation to health, he begins to appreciate the dilemma faced by his patient. Mrs Xian is actually afraid that the combinations and temperature of Western food may harm her and prolong her recovery.
Trevor approaches the Nurse Unit Manger (NUM) to request a variation of her diet for Mrs Xian. He suggests that if the kitchen cannot meet the request then perhaps the family could bring in the food. This request is met with, “I was taught that all patients are to be treated the same way. Any exceptions means that nurses discriminate. I have never discriminated against a patient and I’m not about to start now. If we do it for Mrs Xian, everyone would do it and we’d lose all control.”
Despite Trevor’s description of how weak his patient was becoming, his request was denied.
• What happened in this scenario?
• Where did culturally appropriate care break down?
• How could the NUM have dealt with this more effectively?
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TOPIC 2: RESPECTING CULTURAL DIVERSITY IN THE WORKPLACE
Activity 2.1: 5 MARKS
Demonstration of consideration for others beliefs
Jeanne-Marie hailed from one of the most spiritual cultures in the world. She was admitted because of a threatened miscarriage and firmly believed that her mother-in-law had hexed her. She was distressed and would not stay in bed. Neither would she allow an intravenous line to be established or medication to be administered. The staff were at wits end because they felt powerless to prevent the abortion. This frustration was turned into hostility towards Jeanne-Marie and the situation worsened.
Lise, a French speaking nurse, was able to understand some of the language and correctly interpreted that Jeanne-Marie would only accept help from the shaman or traditional healer. Lise went in search of the husband to see if he knew of such a person. Guillaume was not impressed and was contemptuous of his wife’s regression to voodoo. However, when he realised that what he believed didn’t matter, that he would lose his baby if he didn’t act, he sprang into action.
Within a half-hour, a wrinkled, crone-like woman dressed in a straw skirt and carrying an unlit torch entered Jeanne-Marie’s room. Incantations and the waving of unidentified animal parts occurred. Members of staff were horrified at first but soon they could see that Jeanne-Marie had quietened and was whispering softly. Within a few minutes she was ready to accept treatment.
Lise considered the positive outcome as a personal learning experience.
Can you see that sometimes nurses have to suspend their own belief system, if only briefly, to meet the needs of their patients? Comment on this.
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Scenario 1:
Example of nurses practicing care based on their own belief systems
Samira is a 45-year old Iranian Muslim woman admitted to a nursing home because of multiple sclerosis. She could transfer from bed to chair with assistance but needed significant nursing interventions in her ADL’s. Samira’s mood was flat, she was withdrawn and communicated only when spoken to despite excellent English language ability. The nursing staff were aware of Samira’s social circumstances. She had been divorced by her husband and put in the nursing home so he could re-marry a ‘healthy’ woman. Samira’s three children were not allowed to visit and had been encouraged to believe that their mother was dead. Her daughter, Amali visited for brief periods when she could get away from her father and brothers. The nursing staff were appalled and promptly assessed Samira’s deteriorating mood as having been caused by her abandonment. They decided that they would go out of their way to provide good nursing care to Samira.
The nurses cared for Samira’s hair by washing and styling it using a variety of hair care products. Her skin integrity was maintained using scented creams. Makeup and perfume were applied most days. Staff had even bought pretty, feminine nighties for Samira to wear. Samira continued to deteriorate physically and emotionally despite the nurses’ best efforts. They were confused and frustrated because their attempts at care did not seem to be working. A member of Samira’s religious prayer group came to visit and immediately shouted, “cover that woman up”. Within 10 minutes Samira’s head and arms were covered, all trace of makeup and perfume had been removed and the Koran, had been placed at her bedside. The transformation in her mood was instantaneous. A small smile was visible and she accepted a cup of tea with no argument. The nursing staff requested an in-service teaching session because they wished to prevent such a gross misunderstanding from ever happening again.
Can you see how everything went wrong because of an assumption based on culture care knowledge? The caring demonstrated by the nursing staff is exemplary but it did not take into account the culture of the patient.

Activity 2.2: 4 MARKS
Guided Imagery
• Sit in your chair as comfortable as possible, or sit on the floor if you wish.
• Close your eyes and breathe deeply.
• Relax your body by sequentially contracting and relaxing every muscle you possess from your forehead to your toes.
• If you are a member of the dominant Australian culture imagine that you are in a foreign country, do not speak the language and have urgent medical needs.
• If you are from a non-English speaking background, imagine that you are a member of the dominant culture and encounter a non-English speaking background patient with urgent medical needs.
Identify your feelings. What potential conflicts did you imagine? How could you solve your dilemmas?
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Activity 2.3: Culturally Congruent/Appropriate Care 4 MARKS
Read following scenarios and answer questions below
Culture Care Preservation:
Rajani had rejected all further treatment for her advanced cancer. She asked permission for family to bring in her prayer mat and that she be assisted out of bed to pray at the appropriate time.
Culture Care Accommodation:
Nga is a recently diagnosed diabetic who now must come to terms with insulin administration and dietary restrictions. She initially rejects both concepts but the diabetic nurse educator shows Ling how she can manage her diet within Yin and Yang guidelines. She also shows her how to care for her feet using traditional Chinese herbal creams.
Culture Care re-patterning:
Mrs Wong has just delivered her second baby and is very happy to have had a boy. She tells the nurse that with a toddler at home she is very much looking forward to staying in bed for 40 days. Patiently the nurses explain to Mrs Wong that a variety of complications could develop including clot formation, pneumonia or post partum infection. With great reluctance but increased understanding, Mrs Wong walks up to the nursery to see her baby.
• What may the effect be on the patient when the nurse’s perspective overrides that of the patient?
• What may the effect be on the patient and the nurse when cultural beliefs are incorporated into the delivery of care?
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Activity 2.4: 5 MARKS
Areas of Potential Conflict
Joanna is a 52-year- old Greek Australian wife, mother and grandmother. She is very proud of her family and has brought many pictures into hospital. She talks to the pictures frequently and sometimes cries. Joanna speaks English quite well but assessment reveals that her accent is growing stronger and it is difficult to understand some phrases.
Joanna knows that she is ill but trusts the doctors, nurses and her family to make things right again. She prays often and has requested to see the Greek Orthodox priest. Joanna asks no questions about her illness or its treatment. This has been assessed as lack of interest in her own health and a lack of knowledge about the disease process. Whenever the nurse attempts to inform Joanna of what is happening, she responds by emphatically saying, “Tell my husband”.
Lisa is a new Division 2 graduate nurse who is caring for Joanna for the first time. She is impressed with Joanna’s gentleness, patience and the respect she shows Lisa. Lisa can’t believe that this is the same woman who was described in handover as non-compliant, lacking in knowledge, language challenged and apathetic. Something must be wrong.
Lisa was familiar with evidence-based practice and decided that before she went any further she needed to find out more about Joanna’s culture. At morning tea, Lisa sat with Helen, a Greek Australian nurse. She explained the situation and Joanna’s diagnosis of terminal ovarian cancer. Helen informed Lisa that there is potential for great harm if the Western model is adhered to. In the Greek culture, the person who is ill trusts those around them to make them well. The patient does not want to know the diagnosis, particularly if it is a bad one. The family should be told so that they can care appropriately for the patient but if Joanna is told her diagnosis, Helen warned that she will die much quicker.
Lisa informs the treatment staff of Joanna’s way of dealing with her illness but the doctor states that it is unethical to inform the family before the patient and, even then, not without consent. Joanna is informed of her diagnosis and immediately discharges herself. She will not accept any palliative care and dies within two months without ever having left her bed.
• Do you believe that cultural imposition occurred? Why?
• Can you identify any inappropriate nursing diagnoses that could have been made?
• How could a more positive outcome for Joanna have been achieved?
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Activity 2.5: 2 MARKS
Define ‘culturally appropriate nursing care’
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TOPIC 3: COMMUNICATING EFFECTIVELY WITH CULTURALLY DIVERSE PERSONS
Activity 3.1: 5 MARKS
Silence – Sofia’s near death experience
Sara, a nursing student, approached her new patient Sofia for the first time. Sofia had undergone gallbladder surgery 24 hours previously and was not recovering well. She would not allow Sara to touch her as she continuously moaned and cried out in pain. Vital signs showed slight hypertension and tachycardia, which Sara correctly interpreted as a physiological response to pain.
The drug chart showed that Sofia had received IM Pethidine 2 hours ago and was not due for another injection for a further 2 hours. However, she could have an oral analgesic for breakthrough pain.
Sara reported her patient’s distress to the NUM who responded with “When you have been in nursing for as long as I have you will know that all Italians moan and groan as loudly as they can. It’s just the way they are”.
Sara was not impressed with this response so she paged her clinical teacher. Carmel spoke Italian and assessed diverse abdominal pain as inconsistent with a normal 24 hour post-op pattern. After much discussion with the NUM, the surgical registrar was eventually called to see the patient. Following the registrar’s visit, Sofia was soon on her way back to the operating theatre. It became evident that a suture tying off the cystic duct had slipped and bile was oozing into the abdominal cavity. Without intervention, Sofia could easily have died.
This scenario not only depicts a breakdown in communication but also the potentially fatal outcome of stereotyping.
• Can you think of any other way this situation could have been dealt with?
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Scenario 2:
Communication Check 7 MARK
As a student I had been nursing a female patient for several days and had assisted her to maintain the most intimate of personal hygiene. I encountered her one afternoon in tears after her biopsy results had revealed breast cancer. I handed her a box of tissues and stood powerless by the bed. Her angry response was, “You have seen parts of me that even my husband hasn’t seen with the light on and you can’t even hold me when I’m crying?” I immediately sat down on the bed and wrapped my arms around her, holding her while she cried. I learned more that day than any textbook could ever teach.
Are the questions below true or false? Tick the correct column.

True
False
Words spoken loudly are always indicative of a problem
Aboriginal people like to get straight to the point
Silence can be misinterpreted
Anyone who does not make eye contact is rude
Touch is culturally determined
Language is the most important means of communication
Assessment begins with effective communication
Scenario 3:
Working with interpreters
Nansi was a 38 year old Sudanese Australian admitted to the gynae ward. She had several uterine fibroids that, though benign, had caused dysmenorrhea and menorrhagia. Nansi could speak little or no English but her 12 year old son had accompanied her to hospital.
The admitting doctor chose the most immediate solution to the problem and used Hassan as his interpreter. The assessment included questions about Nansi’s menstrual history, pregnancies and sexual activity. Hassan was too embarrassed to ask his mother these questions so the questions Nansi heard had no relationship to what the doctor had actually asked. Hassan in turn, made up the answers. Since he didn’t know a great deal about the female reproductive system some of the responses were a little out of the ordinary. Hassan’s response to “When was your last menstrual period?” was “not for 3 months”. Based on this data, the doctor quite correctly diagnosed a possible pregnancy and delayed surgery until blood results were back.
The outcome could have been a lot worse. As it was, Nansi did receive the surgery even if it was 24 hours later than it should have been.

Activity 3.2: 5 MARKS
Controlling Stereotypical Assumptions
My patient was a middle-aged man from Saudi Arabia who had paid a small fortune to have his surgery in Australia. I assessed his attitude towards me as dismissive and superior. My first task was to empty his urinal. When I suggested that since he hadn’t had his surgery yet he could use his ensuite bathroom, he yelled at me. My second task was to pour him a glass of water, the third to hand him a box of tissues and the fourth to take his vital signs. As I was completing his BP he touched me inappropriately. Somehow I managed to get out of the room without losing my temper but it was a close thing.
I took time out and sat down to engage in some self-reflection and also reviewed my professional role boundaries. Professionalism certainly did not involve verbal abuse of a patient but I wasn’t sure I could control myself. I decided something had to be done and honesty was usually the best policy.
I told my patient firmly that nurses in Australia were professionals and possessed a great deal of knowledge and expertise. We were considered valuable members of the community and attracted respect. I informed him that I thought we were having a culture clash and that his behaviour was interpreted in this country as sexual harassment. I concluded jokingly by reminding him that I would be the nurse looking after him post-op, so did he really want to antagonise me?
My patient smiled, apologised and thanked me for my honesty. He promised to respect my culture and I made the same vow in return. We never had another incident.
• What are the positive aspects of this interaction?
• Could anything have been done differently?
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TOPIC 4: RESOLVING CROSS-CULTURAL MISUNDERSTANDINGS
Activity 4.1 2 MARKS
Cross-Cultural Misunderstanding
Yung was an elderly Vietnamese lady admitted with dependent oedema related to congestive cardiac failure. She had been sponsored by her son under the family reunification scheme and had only been in the country for a week. Yung spoke no English but her sunny disposition and ability to communicate in sign language prevented any major problems.
Yung had been washing in bed but on her third day she was well enough to go to the shower. Sign language was used to explain where Yung was going. She allowed the nurse to help her undress but became hesitant when asked to sit in the shower chair. However, she sat and was pushed into the shower stall. When the water was turned on, Yung began screaming hysterically as she attempted to get out of the chair. Several nurses came running and eventually Yung was dried, dressed and settled into bed. Her vital signs quickly returned to normal and she slept.
When the son arrived, the nurse asked him if he had any explanation for what happened. He apologised for not having told the staff that his mother might react this way. Yung came from a remote village in southern Vietnam and had never seen a shower in her life. She had looked curiously at the apparatus in her son’s house but had no wish to experience it. The nurse thought she had learned a valuable lesson in cultural assessment.
It is hard to believe that such a simple, everyday event like a shower could strike terror into a patient’s heart. The result could have been disastrous if Yung’s physical status had deteriorated.
• How could this situation have been avoided?
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Activity 4.2 5 MARKS
Racism
Several years ago Cathy commenced studying for her Diploma in Nursing. She was a bright, eager young woman who absolutely radiated warmth and dignity. She was a highly competent nurse who loved to care for people and her patients loved to be nursed by her.
Cathy migrated from Nigeria on a temporary visa. Finances were a problem, so she decided to work as a carer in a nursing home to add to her income. On her first shift, Cathy introduced herself to the team and was immediately met with, “You sure are black and your hair looks like a jex pad. We’ll call you Blacki’. When the staff referred to her or requested her help, she was always referred to as Blacki. Cathy went back the next day, thinking this had been an isolated incident but the isolating, racist behaviour continued. At times she would be the only staff member on the ward because they had all gone to tea without her. She handed in her notice but because of her own strict moral code she worked the remainder of the week and continued to experience racist harassment.
Cathy said that not all staff were actively involved in racist taunts but those who did not participate did nothing to stop it. Cathy finished her course and despite previously wishing to stay in Australia she returned home because she was unwilling to risk any further damage to her well-being.
• Have you ever witnessed anything like this? It is not common, but neither is it rare.
• How can dominant culture nurses improve the relationship with culturally diverse co-workers?
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ACTIVITY 4.3:
Post Unit Delivery Student Self Assessment Exercise
Key to completing columns 1, 2 or 3:
1 = I feel quite confident that I can always do this
2 = I might sometimes need some help
3 = I have no experience in this area
NOTE: Students can draw on work experiences, or if they have not worked, draw on school experiences.
Apply an awareness of culture as a factor in all human behaviour
Can you/do you know how to? How well can you do this? List one example of how you might do this
1 2 3
Work in a culturally appropriate manner.

Work in a way which creates a culturally and psychologically safe environment for all persons.
Review and modify work practices in consultation with persons from diverse cultural backgrounds.
Contribute to the development of relationships based on cultural diversity
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Demonstrate respect for cultural diversity in all communication and interactions with clients, colleagues and customers.
Use specific strategies to eliminate bias and discrimination in dealing with clients and co-workers
Communicate effectively with culturally diverse persons
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Demonstrate respect for cultural diversity in all communications with clients, their families, staff, customers and others.
Constructively use communication to develop and maintain effective relationships, mutual trust and confidence.
Where language barriers exist, efforts are made to communicate in the most effective way possible.

Seek assistance from interpreters or other persons as required.

Resolve cross cultural misunderstandings
Can you/do you know how to?….. How well can you do this? List one example of how you might do this
1 2 3
Identify issues which cause conflict.

Consider cultural differences if difficulties or misunderstanding occur.

Effort is made to sensitively resolve differences, taking into account cultural differences.
Difficulties are addressed with appropriate people and assistance sought when required.
REFERENCES & RESOURCES
Australian Bureau of Statistics, (2007) Australian Social Trends, www.abs.gov.au
Andrews, M and Boyle, J (1995) Transcultural concepts in nursing care, Lippincott, Philadelphia
Carroll, J. (2000) A way of thinking about culture: An Exercise. Oxford Centre for Staff Learning and Development, Oxford
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