Chapter 4. Cultural aspects of children’s nursing
Jim Richardson
LEARNING OUTCOMES
• Explore aspects of your own personal culture and the impact these might have on your professional interactions.
• Express what culture means as a term and appreciate the importance of taking culture into account in children’s nursing work.
• Recognise what aspects of children’s, and their families’, responses are determined by their cultural background.
• Identify strategies for using ideas of culture in everyday children’s nursing activity.
• Explore the dimensions of cultural safety.
What is culture?
It seems difficult to pin down precisely what we mean by ‘culture’, although the term is in frequent use. The word contains shades of meaning that include ‘race’ or ‘nationality’; we now talk of multicultural Britain and transcultural nursing. Equally, culture can be taken to mean the creative product of a society such as literature, music, etc.
An examination of what idea of culture this chapter is offering should help to clarify terms from the outset. The Nursing Council of New Zealand (2002 p 3) defines culture quite simply: ‘culture refers to the beliefs and practices common to any particular group.’
Helman (2000 p 2) expands on this:
Culture is … a set of guidelines … which an individual inherits as a member of a particular society and which tells him/her how to view the world and learn how to behave in relation to other people. It also provides him/her with a way of transmitting these guidelines to the next generation.
Helman (2000) goes on to explain that culture can be seen as an acquired lens through which we see the world. This is a useful analogy because culture can be seen in this way as a sort of filter through which our experience of the world passes and which helps us to interpret it. From these definitions some characteristics of culture can be teased out:
• Culture is learned – therefore, it is acquired. Children primarily learn their culture within the family and immediate community. Later, school life and peers contribute to the growing cultural sense of the child. In fact, it might be said that it is beliefs deriving from culture that dictate how we respond to children and our child-rearing practices.
• It is logical, then, that culture is passed from generation to generation. Some aspects of culture seem to change readily between generations (we don’t tend to think or behave exactly as our parents or grandparents do!). On the other hand, once we have learned and internalised our cultural norms we might well be quite resistant to any change in these.
• Culture is dynamic – it changes while being passed between the generations (the generation gap). It might also change in response to the time, place and conditions within which a cultural group live.
• Culture helps to identify core beliefs. This can include religious belief and spiritual responses. This aspect can be fundamentally important to people during periods of change, stress or crisis, for example, when a child is sick. This aspect of culture can also determine how people interpret health and ill-health, the causes of ill-health and which treatments should be used.
• Culture helps to define our core values. Culture influences us in how we judge what is ‘right’ and what is ‘wrong’ for example.
• Culture has a role to play in the development of our life habits and customs – the way we behave and dress, as well as the food that we eat, are determined by culture. How many of us, in times of stress or tiredness, prefer to eat familiar comforting food from our childhood?
• Culture gives us a pattern for living, it can give us a template for how to respond to crises and difficulties in everyday life.
• Culture is important to us because it dictates how we interpret and respond to the world around us. Without particularly reflecting on this, it can dictate our judgements on the views and actions of others. We tend to regard our own way as correct and might view others as being wrong on the basis of this. For professional people like children’s nurses this tendency might seriously affect the quality of our relationships with those we work with.
• Culture is thoroughly internalised. Having learned our culture in childhood, it is an integral part of ourselves and largely subconscious. When we encounter new situations we tend to see them through our cultural ‘lens’ and make rapid judgements, sometimes without much further thought.
These definitions can be seen to be broad. They indicate that culture is a feature of a wide variety of different groups (Wilkins 1993). One of the bugbears of using cultural ideas in nursing in the past has been the tendency to see culture as being confined to ethnicity. Of course, ethnic groups can be seen as cultural groups but so too can a range of other groups who share beliefs, values and customs. By extension, it is easy then to say that cultural issues concern us all. If we confine our inquiry about cultural aspects to other ethnic groups then we run the risk of not considering our own cultural responses.
If we continue in the vein of considering culture broadly we create the opportunity of seeing a range of cultural groups that we might not otherwise see. It might even be argued that some of the perceived differences in beliefs and behaviours between men and women are based on cultural norms.
Activity
Activity
ActivitySuggest a range of cultural groups that might not necessarily be based on ethnicity.
If we look at groups based on shared beliefs, values and customs on the list you compiled during the above activity we might find:
• Groups based on age, e.g. the elderly and youth might be seen as cultural or subcultural groups because, although they largely share a world-view with society as a whole, they also have distinctive, slightly different perspectives from the majority.
• Groups based on regional origin, e.g. those originating from the north or the south of England, those from the Midlands and those from the south west all carry with them distinct characteristics of groups from their home region. This is clearly illustrated when someone moves from their home region and is struck by the strange habits of the natives of their new home area.
Activity• Stretch your imagination a little further and try to think of other areas that could be defined as cultural. An interesting perspective from the point of view of the children’s nurse might be a suggestion that subcultures might be formed within the healthcare field.
• Consider, with a view to the definitions of culture given earlier, to what extent children’s nurses might form a (sub)cultural group.
If we accept that nurses form a cultural group with a body of shared beliefs, values and customs then, by extension, children and their families do not belong to that group. It will often be observed that ‘experienced’ mothers – that is mothers whose child’s health concerns have brought them into frequent contact with healthcare professionals – often seem to have learned the ‘rules’ of the culture of the healthcare world, including its language. One parent of a child in hospital observed to me that you could always tell ‘experienced’ mothers on a hospital ward; they are the ones who always have a packet of biscuits in their handbag!
It makes sense that parents unfamiliar with the healthcare context might find themselves bemused by the unspoken expectations and rules of the healthcare encounter. It is well documented that implementation of child and family care has been complicated by parents feeling uncertain about quite what is expected of them and not being clear about the unwritten ‘rules’ (Darbyshire, 1994, Coyne, 1995 and Valentine, 1998).
Activity
Activity• Think of a family you have cared for who is deemed by healthcare professionals to be ‘difficult’.
• To what extent do you think that cultural factors, e.g. beliefs, values and customs common to a group, might have been implicated in this situation?
Examples like this illustrate how cultural misunderstandings or lack of insight can hamper collaborative work or even, in extreme cases, form the basis of conflict situations. From this it can be seen how important culture can be as a factor in the everyday work of children’s nurses (Andrews 1995).
Much of what you will read about cultural aspects of health care will appear to contradict this broad reading of what culture is. Many authorities will interpret culture as almost being synonymous with ethnicity. So when commentators describe Britain as being a multicultural society they often mean a multiethnic society. It must be emphasised that the broad reading of what culture is does not negate in any sense the importance of ethnicity in health and social care. Ethnicity is a significant aspect of cultural care issues and caring for children from different ethnic groups often raises very clear cultural questions (Whiting 1999).
www
wwwFind more material about ethnicity and health on the Department of Health website:
One of the problems of considering cultural aspects of culture in children’s nursing is that it can often seem very abstract, and this is often not helped by the complex, sometimes even obscure, language used to describe cultural concepts (Ahmann 1994). Considering some of these ideas in more detail can be useful in illustrating how facets of cultural thinking can be useful in the everyday, practical world.
Ethnocentrism
Although this word appears fearsome it simply describes the situation where we consider our own personal cultural world-view to be correct in all its detail. As we learn our culture from an early age – an important fact for children’s nurses to bear in mind – it tends to be a deeply ingrained part of us. We do not usually consciously consider it when we are making judgements about our experiences. In this way our culture can be compared with Helman’s lens, through which we filter everything that happens to us and colours our reaction to these experiences. Anyone who wears glasses will be aware of how quickly you become unaware of the glasses themselves when viewing the world around you.
Activity
ActivityThink of a situation in which you have disapproved of something that someone else has said or done. Can you think of why you reacted in this way?
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