Calidad y Comunicación

Communication is basic to all human relationships, but it may be a source of distress and misunderstanding between persons from different ethnic groups, especially if the languages are different. Ideally, conversations with families who are unable to speak the dominant language are best conducted by a health care worker who speaks the language of the family. If this is not possible, it may be necessary to engage the services of an interpreter. However, use of an

interpreter can be a source of misunderstanding if the interpreter is unfamiliar with the medical terminology or if there are no corresponding words

:ne second language to express the ideas and concepts .Under discussion (see Communicating with Families Through an Interpreter, Chapter 6).

Some persons with poor or limited language comprehension may simply smile and nod in agreement if they do not understand the questions or directives, It is vital that the family fully understand all implications of a child’s care and management before they sign permits for special procedures or assume responsibility for the child’s care. It is not uncommon for an Oriental family to indicate “yes” when in fact they mean “no” in order to avoid social disharmony.

They tend to use indirectness rather than confrontation and may become evasive when direct questioning makes them feel uncomfortable (Chen-Louie, 1983; Orque, 1983b).

Nonverbal communication is a practiced art in many American Indian tribes, and the members are highly sensitive to body language. They emphasize periods of silence to formulate thoughts in preparation for speech and often remain silent after listening to statements by others in order to properly assimilate what has been said, Interruption, interjection, or haste to arrive at abrupt conclusions is perceived as immature behavior.

Eye contact is viewed differently in cultures, It is not uncommon for persons in some ethnic groups to avoid eye contact and become uncomfortable when conversing with health workers. In non-Western cultures, a patient may not look directly into the nurse’s eyes, as a sign of respect.

Some Native Americans will make eye contact during the initial greeting, but continued, unwavering eye contact is considered insulting and disrespectful (Wilson, 1983).

There may be reluctance on the part of families to question or otherwise initiate contact with health professionals. In the Asian cultures, for example, it is considered a sign of disrespect to question those who are viewed as persons of authority (Orque, 1983b). A Japanese family may wait silently rather than ask or question. They believe that the health professionals know best and will meet their needs without being asked (Hashizume and Takano, 1983). It is also important to avoid criticism. Criticism can cause the Japanese-American to “lose face,” to feel ashamed, which is highly undesirable.

It is necessary to speak slowly and carefully, not loudly, when conversing with families who have poor language comprehension. Many persons are able to read and write English better than they can speak or understand it. Also, the dominant language usually takes over in anxiety-provoking situations, even in persons who are able to communicate satisfactorily under ordinary circumstances.

Terms of address and use of first and last names vary among cultures and can create confusion in institutions. For example, in Asian cultures, the family name is given first in respect for the family and the given names follow. Therefore all siblings in a family have the same first name (in some families it may be the middle names that are the same). Ethiopians use no last names but have a very complex system whereby women retain their last names after marriage and the paternal grandfather’s name becomes a child’s last name. The Mennonites refer to children as sons and daughters of a particular parent, such as “Josiah’s son,” rather than by the son’s name (Elkin and Handel, 1989).

Although all people share the basic emotions, there are decided ethnic variations in the way emotions are expressed. In some cultures (eg., persons of Latin orJewish background) emotions are expressed openly and members are accustomed to share their sorrows and joys with family and friends. Conversely, Nordic and Asian groups are more restrained in expressing emotion.

Nurses caring for persons of another culture will be better able to communicate if they understand the common names used to describe symptoms and diseases: for example, miseries (pain) and locked bowels (constipation) in black people and caida de la mollera (fallen fontanel from dehydration), susto (fright), and la diarrhea (diarrhea) in Latinos.

3.1.3.12 Food Customs

Food customs and symbolism of various cultural, ethnic, and religious groups have become an integral part of their lives. Although in a large country such as the United States most persons have adopted the eclectic food habits that have evolved over countless generations, many ethnic and Geographic food traditions and preferences are retained. Special holidays, ceremonies, and life experiences such as births, birthdays, weddings, and death are often marked by special food items or feasts. In many cultures specific food practices are followed during pregnancy in the belief that certain foods damage the developing fetus.

The distinctive food customs of ethnic groups are a product of their native environment, determined by availability. Fish is a staple food of persons living near the ocean, such as people from Japan, Polynesia, and Scandinavia. Fruit and vegetable preferences are also directly related to the climate in which these grow naturally or can be cultivated. The types of grin that are ethnically associated are also those that grow best in their native lands. For example, rice is the staple grain of the Orient and Pacific islands, wheat of the temperate climates of Europe, rye in Scandinavia, and corn of the North American Indians, The diet of the Eskimo is predominantly fish and meat, depending on which is the most easily procured in the area. Even in the continental United States there are regional favorites, such as rice, horminy grits, and okra in the southern states. In some cultures food is highly spiced; in others foods tend to be bland. Table 2-3 lists the food items common to all cultures, and Table 2-4 outlines some of the foods associated with some specific ethnic groups.

There are a number of restrictions related to food items. Some have a physiologic origin, such as lack of dairy foods in the diets of some persons of African or Asian ancestry with lactose intolerance. Others have religious restrictions, such as kosher foods and food preparation of the Orthodox Jewish faith and the vegetarian diet of Seventh Day Adventists (see Vegetarian Diets, Chapter 13).

Children in a strange environment, such as the hospital, feel much more comfortable when they are served foods to which they are accustomed (Fig. 2-5). The hospital food often tastes strange and bland, especially to children who enjoy the highly seasoned foods of their culture. The family may be concerned that the child is receiving foods appropriate to their culture and beliefs (see Health Beliefs, p. 46). Where possible, it is advisable to provide children’s ethnic foods or allow families to bring favorite foods that are not available on the hospital menu. Concern for differences in food habits and patterns projects an attitude of respect of the family’s ethnic or religious heritage.

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Unit.