Culture and Care
Culture may define to some degree how a person behaves and the attitudes that they have (Durkheim). For example, nurses from some countries may display a more positive attitude towards older people than from other countries. This may be demonstrated in such aspects as respect or dignity. There are NMC cases which involved such as calling an old person names; is it possible that cultural factors influenced the nurse ? This is not to excuse the behaviour, but to heighten awareness of factors involved so as to address the situation.
There is a high use of overseas nurses within all fields in the UK, but especially within the private sector. Duell (in Dimon 2013), discusses that many nurses from overseas complain less. Of course, this may depend on which country they are from. Many countries, discourage the questioning of doctors or more senior staff. How then can we expect such staff to immediately adapt to the UK? There are also differences regarding such aspects as pain control (RCN 2003). Of course, countries may lack the resources and methods that other countries have. Indeed, some people are still expected to have a stiff upper lip and carry on despite pain. This article will explore the difficulties that nurses from other countries may face when adapting to work within the UK.
Culture may be influenced within one country by such factors as affluent areas and poor areas . There are also cultural differences between countries. Obvious differences include religion or tradition . There are present UK campaigns against female genital mutilation within some parts of Africa for example (RCN.org.uk) .
It is indicated that the wealthy have less empathy, which may be hastened by the work ethic- you earn what you get, and their aim to justify their wealthy position (Goleman 2013).
Physical restraint of individuals is used in some other countries to a greater degree than the UK. For example, in some regions of South Africa, there is no community care, so a mentally ill person may be chained to the wall while the relatives have to go to work to earn money to eat. In Somalia, mentally ill patients may be put in a cage with hyenas (Hooper 2013). Therefore, nurses from such countries may well regard restraint as the norm.
Culture also affects expectations of care. Some patients may well accept queuing for a bath with other patients . Some individuals in some countries, as in parts of Africa, still believe in witch doctors and that evil spirits cause mental and physical ill-health.
An analysis of NMC cases indicates that some nurses who are convicted at professional conduct hearings may well be from overseas. However, the NMC does not keep a record of overseas status, unlike the GMC. Such a record would help to monitor the situation. Indeed, nurses from different regions within Africa have been known to refuse to work with or communicate with one another, due to tribal differences.
Finding actual cases of poor care of patients in the UK which may be determined by culture is not easy. There are some newspaper reports that state the nurse was from overseas, there are also cases that involve UK trained nurses who abuse patients.
The following does refer to nursing in Nigeria, but again it may not refer to all nurses;
“Picture this scenario: a nurse is beating a sick patient in bed. Reason : Madam Nurse was provoked by the patient’s groans. A deadlier scenario: a weak but desperate asthmatic patient is in a struggle with a nurse who wants to strangulate him. This triggers an attack and the patient frantically reaches for his inhaler, only for the nurse to smash that life instrument on the ground, breaking but not totally destroying it, before the patient manages to get it out of sheer willpower. This may seem stronger than fiction, but these two events happened only recently. Welcome to the deadly world of Nigerian nursing” (Kowale 2012).
The author questions why, despite the Nigerian Code stating “the nurse must provide care in such a manner as to maintain the integrity of the profession”, such attitudes prevail. Such an example as this indicates that there are people of conscience within all countries.
Simulsesli (2012) further analyses the work of Jewkes et al 1998, asking why abuse of midwifery patients occurs in Zambia. He concludes there are many underlying sociological factors, but they can be challenged by, for example, positive role models, effective complaints procedures, and improved working conditions.
I argue also, there are political factors which fuel the work ethic belief that some people are more deserving than others, because they work.
Indeed, such attitudes prevailed within the UK, and other Western countries, many years ago, as evidenced within workhouse records or by such authors as Barbara Robb. Pregnant mothers were still hit by midwives, until the 1970s in London, according to Jewkes et al 1998. Is it possible that within the UK, and other Western countries, there is a return to this era, with such examples as patients in some hospitals and care homes being tormented and ridiculed.
Of course, I am not saying do not employ staff from overseas from different cultures. There are some excellent staff from overseas . What I am suggesting is that they should be better prepared by a more robust adaptation programme for example, a cultural adaptation course. We consider cultural differences of patients- so why not staff?
Dimon C (2013) The Commodity of Care Cloister House Press
Free updates qualityofnursingcare.webs.com
Durkheim E Ethics and the Sociology of Morals Prometheus books
Goleman D (2013) New York Times Rich People Just Care Less October 5
Hooper R (2013) Where Hyenas are Used to Treat Mental Illness 17 .10 bbcnews
Jewkes R, Abrahams N, Mvo V (1998) Why do Nurses Abuse Patients? Reflections From South African Obstetric Services Soc Sci Med v47 n11 p1781-1795
Kolawole K (2012) Nigeria: Ethical Issues in Nursing Practice allafrica.com 6 December
RCN(2003) “We Need Respect”: Experiences of Internationally Recruited Nurses In The UK rcn.org/publications 1st March
Sumulesli A (2012) Why do Zambian Nurses Abuse Patients? Zambian watchdog.com 22 August
Carol Dimon c 2014