Multicultural Nursing Education in a Multicultural Society

Abstract

The development of the modern field of care requires scientifically-based knowledge and responsibility on behalf of nurses in order to be able to respond effectively to existing conditions. Health professionals have a key role in the modern social structure with the overarching goal of optimizing the health status of citizens. Therefore, in determining the shape of society certain factors should be examined. These include cultural, political, economic, environmental, behavioral and psychological. This study aimed at identifying the significant role of nurses in Cyprus concerning the care to be provided among people of various nationalities, religion groups, immigrants and minorities. This literature review study was carried during August - October 2012. Various electronic data resources were investigated without any particular selection criteria. Most important data were those obtained by the Statistical Service of the Planning Bureau of the Republic of Cyprus. The study gives the importance of a cross-cultural approach while providing holistic and individualized care to patients and briefly summarizes the existing situation in Cyprus.

Headnote

Abstract

Backround: The development of the modern field of care requires scientifically-based knowledge and responsibility on behalf of nurses in order to be able to respond effectively to existing conditions. Health professionals have a key role in the modern social structure with the overarching goal of optimizing the health status of citizens. Therefore, in determining the shape of society certain factors should be examined. These include cultural, political, economic, environmental, behavioral and psychological.

Aim: This study aimed in identifying the significant role of nurses in Cyprus concerning the care to be provided among people of various nationalities, religion groups, immigrants and minorities.

Methods: This literature review study was carried during August - October 2012. Various electronc data resources were investigated without any particular selection criteria. Most important data were those obtained by the Statistical Service of the Planning Bureau of the Republic of Cyprus.

Results: The study gives the importance of a cross-cultural approach while providing holistic and individualized care to patients and briefly summarizes the existing situation in Cyprus. Furthermore, it designates the importance of introducing or further expansion of nursing education accordingly to multiculturism and provision of nursing care for the benefit of the Health status of the population.

Conclusions: The phenomenon of a cross-cultural approach is of great importance in the areas of nursing education, policy and research and enables nurses, among other health professionals to perform their duties in multicultural environments and meet the needs of patients from different cultures. Further studies and comprehensive research is advised to obtain valid and concrete data on the existing situation and the impact on the health services.

Keywords: Culture, Multiculturalism, Interculturalism, Nurses and Nursing Care.

Introduction

The development of the modern field of care requires scientifically-based knowledge and responsibility on behalf of nurses in order to be able to respond effectively to existing conditions. Health professionals have a key role in the modern social structure with the overarching goal of optimizing the health status of citizens. The field of intercultural care requires professionals with wide-ranging expertise to deliver quality health services. In determining the shape of society, cultural, political, economic, environmental, behavioral and psychological factors should be examined.

Multicultural society

Cyprus has become a host country of immigrants. According to the latest statistics from the Statistical Office of the Republic (Statistical Services of Cyprus, 2011), Cyprus 'hosts' 106,270 nationals of other EU countries and 64,113 nationals of other countries. The sum of these populations represents 20% of the total population in Cyprus.

* The presence of a large number of immigrants raises new issues in contemporary perception as shaped in cultural behavior patterns.

* In particular, new issues emerge, linked to the school / society and require:

* Intercultural education, due to the structure of the multiracial, multicultural society.

The objectives of professional training in this type of society, are taking the form of mediation between different cultures - Mediation and continuous and fruitful interaction between the various existing models.

Definitions

Multiculturalism: Refers to the physical condition of societies, in which the identified differences relate primarily to linguistic, ethnic and religious characteristics.

Interculturalism: Refers to a creative process, which requires the acceptance of the other's culture, not in terms of knowledge, but the cultures as such in general, on many levels.

Includes an interactive dimension and enhances the ability of individuals to create and establish common identities.

Implies interaction, reciprocity, real solidarity (Cyprus Ministry of Education 2006).

Principles of Interculturalism

* As formulated by Helmut Essinger the 4 basic principles of interculturalism (Essinger, 1990) are: Empathy, understanding ie, problems and diversity by placing Self in the position of Others,

* Solidarity and collective consciousness, which proceed beyond the boundaries of groups and states and fighting social inequality,

* Respect for cultural diversity with openness to different cultures and

* The fight against ethnocentric thinking, that reduces prejudices and stereotypes.

Multicultural Education and Democracy

The term Democracy acquires value from intercultural training / behavior. In the Democracy, the cultural difference is considered as a positive force that helps both the society and each individual mature.

It accompanies the acceptance and respect for diversity, and the recognition of cultural identity through a daily effort in dialogue, understanding and cooperation (Ministry of Education, 2006).

Intercultural education involves:

* Tolerance of deviant behavior,

* Recognition of foreign habits

* Acceptance of multilingualism,

* Free exercise of religious activities as a private affair.

To have empathy and elimination of nationalistic ways of thinking, so that it can meet the personal culture of each person with that of its neighbor (Aggeli, 2006).

Interculturality and identity

* The culturalism and the respect for foreign culture, behavior and thinking, language, religion, customs and traditions, does not mean disrespect our own tradition and ethnic, religious identity.

* Respecting foreign traditions means we can respect our own at the same time. In other words: "The man who does not respect the foreign tradition cannot respect his own culture and tradition."The human "contact" is a need!What makes humans "humans" is the sense of the need for human coexistence.

Intercultural Care

Perhaps the first, nurse-researcher, who realized the need for the timely approach to nursing problems from a different perspective was Madeleine Leininger. Because she dealt with different groups of people she experienced the emergence of new concepts and knowledge regarding nursing, such as "Intercultural Care" '. Madeleine Leininger developed the theory of cultural diversity and universality in Nursing Care (Leininger, 1997).

Cultural awareness

Nurses need to develop cultural awareness and sensitivity to provide the appropriate "quality care". Cultural awareness involves knowing the ethnic history of the individual and showing respect for their festivals and artistic expressions. It also includes an awareness of personality, values, beliefs and prejudices.

It includes showing cultural sensitivity and respect to acceptable forms of communication, avoidance of offensive language and of opinions that offend the religious beliefs of the individual. The formation of an "open" spirit and understanding of the world through a different cultural man is another aspect of cultural awareness (Fili & Papadopoulos, 2011).

Difficulties in the delivery of care

The obstacles encountered by nurses providing care to populations with different cultural backgrounds are:

* Difficulty in language and communication.

* Lack of knowledge regarding cultural differences.

* Difficulty in developing therapeutic relationships.

* Difficulty in explaining the provision of health services.

* Lack of knowledge regarding alternatives to diet, which are consistent with cultural preferences and habits of the patient (Fili & Papadopoulos, 2011).

Problems in the provision of care

During the care of a patient from a different culture, nurses need to pay attention to issues such as:

* The way to address people.

* The need for an interpreter.

* Whether eye contact is considered polite or rude.

* Complicity with the physical distance between the speakers (If appropriate for conversation).

* The importance of non-verbal messages such as gestures, posture, etc.

* By whom, when and where physical contact is acceptable.

* By which members of the family the decisions are taken (Fili & Papadopoulos, 2011).

Nursing Education

The purpose of Nursing Education should be the proper preparation of nursing students to develop intercultural competence, i.e. the ability to work effectively within a particular culture.

Therefore, adjustments of the nursing curriculum should be made, in order to include the principles and theories of Intercultural Nursing. Consequently, during the course of their studies, students should be properly prepared in order to gain the ability to provide holistic care to people belonging to different cultural groups (Gerogianni & Plexida, 2008).

Acceptance

At the same time, they need to realize that it is important to respect and accept different beliefs people from different cultures have, although these may not keep pace with theirs (Kalokerinou et al., 2003).

For this reason, the national strategy of educational programs at all levels should be based on the core principles of a multicultural society, which are:

* Freedom and equality that allows diversity

* The right to expression of cultural values and beliefs

* The productive diversity for public benefit

* Social justice, which consists of the equal treatment of different cultural groups, and the equal opportunities without racial, linguistic, cultural, and religious discrimination (PNEiTE, 2011).

Objectives of Nursing Education

Nursing education must focus on a multicultural orientation, which should include:

* The awareness of nursing students in multicultural concepts in the context of the Intercultural Health Care.

* Continuous provision of knowledge about the cultural differences of the various cultural groups.

* Achieving a level of cultural competence in education.

* Aiming a humanitarian training standard, which will provide all necessary skills to nurses.

Therefore, Nursing Education should be linked with the elimination of discrimination, fairness, mutual understanding, mutual acceptance and solidarity.

Furthermore, Nursing is free from barriers, ethnicity, race, religion, color, age, gender, political and social situations. Nursing is a humanistic science and art, which is addressed to the people, the family, the society, and exists in all states of health and illness. Therefore, the teaching of Intercultural Nursing is essential not only in theory but also in practice to students attending nursing schools (PNEiTE, 2011).

Proposals for Nursing Education

To achieve an effective Nursing Education in Cyprus in the context of a multicultural society, the following proposals are set:

* The lesson of Intercultural Nursing in every educational institution should be mandatory and not on a voluntary basis, as it is today. It would be appropriate to be added to the curriculum together with the lesson of Anthropology.

* Nursing education should be provided by qualified staff that will transmit properly the principles of Intercultural Nursing students.

* Additionally, it is necessary to use teaching staff from different cultural minorities. Meanwhile, students from different cultural backgrounds can help with their experiences and provide an important source of knowledge for other students.

* During their studies students should be provided with comprehensive information about the population heterogeneity of modern society

* The teaching staff needs to inform students about the social conditions in which people live in different cultural groups.

* Students should be informed about issues such as the identity of these populations, as well as the endemic diseases prevalent in the regions of their origin. In addition, students should be aware of their living conditions in our country, which is likely to favor the emergence or transmission of various diseases.

* In addition, during their internship, students should be given the opportunity to provide care to groups of people of different nationalities, cultural backgrounds and economic status. This can be achieved by placing them in areas of clinical practice such as health centers, which are located mainly in areas inhabited by people of different cultural backgrounds.

* It is considered essential to implement various programs of Intercultural Nursing for students and graduate Nurses, in collaboration with the departments of Anthropology, Sociology and Ethnic Studies.

* Additionally, much more support for student exchange programs and personnel (eg Erasmus, Socrates, Leonardo Da Vinci) should be given.

* In this way, an opportunity is given to both the students and the faculty to learn about new cultures, customs and traditions and to adapt more easily to the Greek multicultural reality.

* At the same time, Nursing education should give great importance to conducting research studies on the diversity of cultural groups. Still, it is advisable to adopt new teaching methods by teachers, such as learning through the use of health scenarios and reflection. It is also required that organization providing training courses, seminars, and discussions to students and working Nurses, to acquire theoretical knowledge in order to provide holistic care to people of different cultural backgrounds.

* It is worth emphasizing the need to provide continuing nursing education to graduate Nurses, to meet the educational needs of Intercultural Nursing issues.

* Finally, schools of nursing libraries as well as libraries of the various hospitals, should include journals and books regarding Intercultural Nursing (Kotzabassaki, 2004, Gerogianni & Plexida, 2008)

The importance of a cross-cultural approach

Providing holistic and individualized care to patients is a major challenge for nurses and generally for health professionals, especially in societies where the composition of the population varies in cultural, linguistic, religious and national level.

This phenomenon is of great importance in the areas of nursing education, policy and research to enable the nurses to perform their duties in multicultural environments and meet the needs of patients from different cultures.

The need for intercultural nursing will continue to be an important aspect in providing healthcare. Nurses need to acquire the necessary knowledge and skills to recognize and appreciate the cultural differences relevant to the values, beliefs, customs and rituals of each cultural group.

The knowledge of ceremonies and rituals which have their roots in the cultural heritage of each nation to honor and mourn the dead and to facilitate the process of expressing feelings of grief and healing will promote the relationship of trust between patients, their families and health professionals. It will sensitize health professionals, foster empathy and improve service quality and efficiency.

When a person has the need to contact a professional for health, it is natural to contact professionals with whom he or she shares a common culture, language and history to develop a relationship of trust and security and to have better communication, more understanding and support. Nurses can help people to "live well" to "die well", to "mourn well and get adapted to loss" only if they know their cultural specificities and the role played by culture in the course of each person (PNEiTE, 2011).

Cyprus Situation

The regulation of entry of immigrants in Cyprus is based on the provisions of the harmonization with European Directives, Aliens and Immigration Law. Large numbers of immigrants in Cyprus are political refugees, asylum seekers, illegal and legal resident immigrants.

In recognition of the Ombudsman, there are weaknesses and problems, especially with regard to the establishment of long-term immigration policy.

It has also been found that the smooth integration of immigrants in the society is an essential issue that needs proper handling on behalf of the state and citizens to address the challenges arising from the provision of healthcare services (Sourtzi, Taylor, Apostolara, Kouta, 2011).

The health problems that immigrants face, particularly if they are living under difficult conditions and have low wages, should be carefully examined in order to avoid potential public health problems (Sourtzi et al., 2011).

Discussion/ Conclusion

Culture plays an important role in patient care in a multicultural society. Patients may get much more benefit from culturally adjusted health services. Nurses should and must have the necessary knowledge to effectively approach and care patients coming from various cultural groups.

Therefore, nursing education should aware and inform students about the characteristics of people from different social groups, aiming to improve the delivery of Transcultural Health Care in the context of a multicultural society.

References

References

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