Developing Nurses Cultural Awareness - Assignment Example

Introduction Human diversity is a complex issue for the nurse, that has many inter-linking facets providing novel situations, ethical dilemmas, and also a wealth of skills, knowledge and competencies to solving critical health and social care issues. Nursing is a social activity and so the range of patient, co-worker and the general public temperaments that personal will come into contact with is vast (Carillo, Green, & Betancourt, 1990; Chevannes, 2002; Serrant-Green, 2001). In order for these therapeutic relationships, however brief, to have an impact on the healing process, it is apparent to that a nurse must develop their communication, caring, justice and fairness skills. With regard to staff development, it is recognised that nurses are expected to understand human development and learning processes to provide themselves and patients with efficient and effective education experiences. Renowned education researchers Morris Bigge and Samuel Shermis (1998), use their text Learning Theories for Teachers to motivate teachers and learners, in this case nurses, to develop their own theories of learning, and to evaluate such theories within the workplace environment in which learning and development occurs, thus using an evidence-based approach. The text aims to encourage learners to draw on education theories to enhance their foster an experimental attitude toward modifying delivery methods to optimise professional development. This paper will briefly review education theories contribution to developing nurse's patient cultural assessment skills. Firstly, a description of the responsibilities of nurses (in the 21st century) to multicultural issues will be presented. Secondly, how awareness to the needs and expectations of ethnic minority patients can be taught to nurses will be explored. A conclusion will synthesize the main points of the paper and place it in the larger context of clinical governance for nurses in the UK. A Review of the Literature The Need for Cultural Awareness Among Nurses Communication, care and justice and fairness within nursing are critical issues as staff must be able to engage with, and develop therapeutic relationships with a diverse range of individuals, cultures, communities and aggregate groups that comprise a community (Var, 1998). In order to be sensitive to the human diversity of patients, it is evident to that a nurse must continually develop skills of sensitivity to other's ways of expressing their needs, expectations and responses to health care issues (Gerrish, 1998; Vydelingum, 2006). Further, the nurse must cultivate an awareness of the socio-political issues within the community which will impact on decision-making of patient care; such as gender roles, issues of multiculturalism, and social protection of the socially excluded (e.g., minority groups). The Critical Need for a Psychological Approach to Education Bigge and Shermis make it clear that the discipline of psychology is essential to further the understanding of professional development processes. The science of psychology focuses its study area on the mind of the individual, often drawing on cognitive, emotional and behavioral responses to measure and determine the mind's structures and functions. It is generally conceded that many human behaviors are learnt, and so psychologists have sought to identify a learning theory that explains learning processes (Johansen, 2000). The professional development of nurses can in turn draw on this knowledge base to inform and create ideal therapeutic relationships with patients. The text presents contemporary learning theories as emphasising cognitive, socio-emotional and physical aspects of learning across the lifespan, which in this case can be applied to staff development of cultural assessments. Behaviourism as an Education Theory in Nursing The two major learning theories of relevance to current education approaches are the behaviorist and the cognitivist schools of thought. The behaviorists focus on observable behavior and reduced the learning experience to a process of stimulus and responses. This psychology approach to learning was adopted in the USA during the early 1900s, when science and technology were experiencing a time of accelerated growth. Hence, the concept of studying measurable, objective, human behaviors aligned with current values of a modernised society embracing standardised production methods (Bigge & Shermis, 1998). For the extreme behaviorist, all human behavior can be understood through the processes of conditioning, these being classical and operant in form. B. F. Skinner is famous for his development of the principles of operant conditioning, that is, that any behavior is shaped by the consequences that follow it. Skinner pointed out that a positive, negative or neutral consequence following a behavior influenced whether a particular behavior was repeated in the future, or if it was not (Bereiter, 2002). For example, if a nurse is unaware that some ethnic minority cultures do not condone a woman being in a position of authority, she may experience frustration and resentment when if a male patient of a minority group does not listen to her requests or advice. The feelings of "frustration" or "resentment" may then condition the nurse to avoid attending to male patients of minority groups, or to treat them in a different manner to males of other cultural groups. Male ethnic minority patients would be associated with negative feelings for the nurse. However, the Skinner's theory holds that a person can learn new behaviors, or is able to modify existing behaviors, as a function of environmental events that either reward or punish that behavior (Bigge & Shermis, 1998). For example, the nurse may be shown how the use of a male liaison when communicating with males of an ethnic minority group circumvents her feelings of frustration, and so her perceptions of the group in question are conditioned to be positive. When the male in question answers her question (via the liaison), the nurse is rewarded as she feels her role is validated. In this way, Skinner's learning theory is a move away from the traditional behaviorist approach of stimulus and response, as he differentiated between types of responses. When a response was elicited by a known stimulus it is considered to be associated with the known stimulus. Alternatively, responses that do not require a specific stimulus, which he termed operants, are independent of the stimulus. Skinner emphasised that it was the operant response that could be strengthened or weakened by use of personal, social or environmental rewards or punishments (Bigge & Shermis, 1998; Bereiter, 2002). For example, the nurse in the previous example is aware that she has some control over the situation by making use of a male liaison, and having her questions answered or advice followed through on provides the nurse with a personal reward. The behavioural approach would require the instruction for nurses professional development in cultural awareness to be delivered in small components (Bigge & Shermis, 1998); for example, ethnic minority groups in the UK, gender roles across different cultures, strategies to engage with male patients of these groups in a therapeutic relationship. Each component is systematically built on (Bigge & Shermis, 1998), so that cultural awareness is developed in a logical and sequential way. As a set of 'instructions,' the step-by-step procedure aims to shape the behavior of the nurse to a predetermined outcome: cultural awareness. However, Skinner's theory ignored the contributions of cognitions, with mental activity being considered a 'black box' devoid of meaning as the activity could not be objectively observed and so could not be reliably measured. Additionally, his behavioral approach did not seek understand why a student, such as a nurse, learns in the way that they do, or acts out behaviors that they do (Bereiter, 2002). Cognitivism as an Education Theory in Nursing Alternatively, cognitive approaches challenged the concept of behavioral theory that it was the environment that determined a person's behavior. Cognitive learning theorists advocated that a person actively participates in the acquisition of new knowledge (Bigge & Shermis, 1998). Additionally, cognitivists highlighted that not all learning is observable, such as with mental representations within the mind of a person, and the processes of memory and thinking, which could be measured by way of interviews or surveys of people, as well as observations of external behaviors. The cognitive approach pointed to the learning development of children, wherein they do not just respond to their environment, but actively engage in making sense of the world and their experiences within it, and using their own guesswork as to how the world is structured and functions (De Vris, 2000). Constructivist learning theory (a post-modern cognitive theory) maintains that a person actively engages in the learning process. As such, for a nurse, they construct their understanding of ethnic minorities, and their experiences with these groups are used to ascribe meanings to their experiences (Bigge & Shermis, 1998). For example, a male nurse attempts to take blood from a female patient of whose culture is fundamentalist Moslem. The woman becomes quite agitated and vocally distraught when the nurse touches her arm to prepare her for the procedure. The male nurse is embarrassed that he has caused her offense, and feels resentful that the woman has perceived him in such a negative manner. Subsequently, the male nurse becomes anxious and short-tempered when expected to engage with female patients of another culture, often delegating the task to another on some pretext. Over time, the male nurse finds it more and more difficult to find excuses to avoid female patients of other cultures, and his resentment builds further. To the point that whenever he must enter a therapeutic relationship with a culturally different female patient, he is abrupt in tone, and avoids direct contact with them. It is the social interactions, and environmental engagements that on a daily basis contribute to how each person constructs their interpretation of reality that is the basis of constructionist theory (DeVries & Zan, 1992). Importantly, constructed knowledge need not correspond to an external reality in order for the knowledge to be useful, because knowledge is useful when it 'fits' the needs of the learner. Hence, a teacher or nurse facilitator is able to communicate cultural awareness to the male nurse in question, even though he has not as yet had a rewarding or positive experience with a female patient of a different minority group. By exposing the nurse to information about cultural differences, gender roles and acceptable strategies for engagement during the therapeutic relationship, the male nurse can develop more positive feelings toward the women, and more positive meanings of his experiences. Ultimately, state the constructivists, knowledge is not directly transferable between people, such as from an expert to a novice, or through attending lectures or reading textbooks, as each person's unique experiences means that the information presented is interpreted differently (Bigge & Shermis, 1998). Hence, no two people will have exactly the same understanding, or interpretation of knowledge. How Education Theory Families Differ Bigge and Shermis point out that, the biggest difference between the learning theory families is their perception of the learner, in this case nurses. The behaviorist approach views the student as a passive and reactive organism that can be programmed with new knowledge by way of instruction from an expert. Whereas the constructivists take a learner-centered approach, advocating that the student interacts with their social and physical environment, and so actively engages in the learning process. Further, that the student requires a personal involvement in the acquisition of knowledge in order to learn the material optimally, and to subsequently apply that knowledge effectively and efficiently. Conclusion It is critical that nurses develop cultural awareness to be able to interact effectively and efficiently with the diverse cultural groups that exist in world of expanding globalization. A health promoting therapeutic relationship is unable to occur without the ongoing professional development of nurses in areas of communication, multiculturalism and reflection on personal belief systems and values and how these impact on working with those from another culture. Patients may have an assortment of concepts about health and health care that do not correspond to Western practices and beliefs. However, this does not negate the legitimacy of their belief systems; it merely indicates areas of health care provision that requires continuous debate and discourse to ensure cultural inclusiveness, and the best treatment for the patients across cultures. The text Learning Theories for Teachers encompasses a rich overview of the current dominant learning theories, and presents a critique of the consequences in the present day of adopting each theory within the teaching/facilitator practice. It appears that a nurse would do best to incorporate facets from each theorist into their professional development of cultural awareness, although incorporating a constructivist approach as a key teaching value is contended here to be the best guiding learning theory. It is recommended that nurses in training, as well as nurses already in public and private practice test each of the learning theories within the work context, to facilitate the nurse's conceptualisation and practical application of each theory. This will cultivate greater understanding of the theories themselves, as well as provide effective and efficient guidance for the nurse to adapt their professional development, be it for cultural awareness or any other staff development issue. References Bigger, M. L. & Shermis, S. S. (1998). Learning Theories for Teachers, 6th ed. New York: Allyn & Bacon. Bereiter, C. (2002). Education and Mind in the Knowledge Age. London: Lawrence Earlbaume Associates. Carillo, E. J., Green, R., A., & Betancourt, J. R. (1990). Cross-cultural primary care: A patient- based approach. Retrieved January 31, 2007, from http://www.annals.org/cgi/reprint/130/10/829.pdf Chevannes, M. (2002). Issues in educating health professionals to meet the diverse needs of patients and other service users from ethnic minority groups. Journal of Advanced Nursing, 39(3), 290-298. De Vris, R. (2000). Vygotsky, Piaget, and education: A reciprocal assimilation of theories and educational practices. Retrieved January 31, 2007, from http://www.uni.edu/coe/regentsctr/Publications/Vygotsky%20Piaget%20and%20Edu.pdf DeVries, R., & Zan, B. (1992). Social processes in development: A constructivist view of Piaget, Vygotsky, and education. Paper presented at the annual meeting of the Jean Piaget Society, Montreal, Quebec, Canada. Gerrish K. (1998). Preparing nurses to care for minority ethnic communities. International Nursing Review, 45(4),115-6, 118, 127. Johansen, D. (2000). Theoretical Foundations of Learning Environments. London: Lawrence Earlbaume Associates. Serrant-Green L. (2001). Transcultural nursing education: A view from within. Nursing Education Today, 21(8), 670-8. Var, L. (1998). Improving educational preparation for transcultural health care, Nursing Education Today, 18(7), 519-33. Vydelingum V. (2006). Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England. Nursing Inquiry, 13(1), 23-32. Read More