Best Practices

Contemporary methods

• Perspective-taking is an approach which encourages caregivers to take the patient’s unique sociocultural background into consideration, as it may affect:
  • How they present their symptoms (stoic versus emotive)
  • Their threshold for when to seek care (proactive versus reactive)
  • Comprehension of care strategies (limited versus deep health literacy)
  • Expected outcomes of care (holistic/therapeutic versus medical/diagnostic)
  • Likelihood of adherence or compliance with preventive measures, medication regimens, follow-up, and inclusion of alternative modalities
• There is no single superior paradigm for providing appropriate and meaningful culturally- sensitive care to patients.
• Available research supports the education of bedside caregivers in cross-cultural care to maximize patient outcomes.
• Caregivers that are educated to acknowledge and respect sociocultural differences show improved attitudes toward patients, with more respectful and effective communication patterns.
• Acknowledging the historical racial, gender, social, and ethnic disparities endemic in the healthcare system can lead to more meaningful and effective clinical encounters for both clinicians and patients.

Communication Pearls

• Current research supports a balanced approach to communication, building trust with patients, and acknowledging differences in order to transcend them.
• The literature lists the following as core cross-cultural issues to address with patients navigating the healthcare system:
  • Communication styles
  • Prejudices and mistrust
  • Family dynamics and decision-making
  • Traditions, customs, and spirituality
  • Gender and sexuality issues
• Time constraints are an oft-cited barrier to effective cross-cultural nursing, as it takes time to fully assess and to establish a trusting relationship with new patients.
• Use interpreters to assist patients with limited English-language proficiency. Avoid common pitfalls of effective communication using interpreters.
  • Remember to make eye contact with the patient and address the patient, not the interpreter.
  • Position the interpreter so that everyone can see one another.
  • Avoid medical terminology and acronyms.
  • Instruct the interpreter to alert you if they perceive any communication issues.
  • Keep questions short and ask one at a time.
  • More detailed guidelines can be found here.
• Routinely assess for understanding, utilizing a teach-back technique.
• Ask patient about their desired level of family involvement in their decision-making, respecting their autonomy as well as their possible desire to include family members or defer to their choices.
• Use open-ended questions to elicit patient and family input and preferences and be willing to incorporate preferred modalities and treatments as appropriate.
• Alternative therapies and treatments should be considered as adjuncts to care and included whenever possible in accordance with patient and family wishes.