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Family and Cultural Care of the Critically Ill Patient 165

WORKING WITH CULTURALLY fundamental belief that illnesses are caused by some
AND LINGUISTICALLY DIVERSE external force.
PATIENTS AND FAMILIES For many cultural groups the presence of family is vital to
Globalisation has resulted in increasing immigration and both the patients’ and family’s spiritual wellbeing. There-
migration in both Australia and New Zealand, thus popu- fore, facilitating family presence at the patient’s bedside
lations are increasing in their cultural and linguistic diver- and possibly including them in the care of the patient is
sity. In 2006 Australians and New Zealanders comprised important. For some cultures there is a belief that family
24% and 20%, respectively, of peoples who were born members should shoulder the burden of information and
overseas. Immigrants arrive from various countries glob- decision making so the patient can expend their energy
ally, but especially the European, Asian and African con- and focus on getting better. In some cases to burden the
tinents. Labels assigned to groups of ‘immigrants’, such patient with information about their condition, espe-
as Asians, are misleading and far from the homogeneity cially its gravity, or having to make decisions, is believed
they infer. Added to the complexity of trying to determine to contribute to a negative outcome. Thus, positively
ways of working with culturally and linguistically diverse engaging families and where practical patients in collab-
patients and families is the variation in their degree of orative relationships, involving them in the care and deci-
acculturation – for example, some may be second- or sion making, and ensuring their cultural values, beliefs
third-generation Australian- or New Zealand-born and and practices are protected, are ways critical care nurses
highly acculturated into the respective culture, or they can respect the cultural traditions of those patients who
may be new immigrants with traditional cultural beliefs are from different cultural and linguistic backgrounds.
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and practices. Therefore, given this diversity it is difficult Campinha-Bacote’s mnemonic, ASKED, provides a
to provide specific guidelines on working with culturally process for self-reflection to make explicit your knowl-
and linguistically diverse patients and their families, edge and skills and desires to work with people who are
although some common principles exist. culturally and linguistically diverse. The following ques-
A fundamental starting point for working with culturally tions can be asked:
and linguistically diverse patients is to establish their ● Awareness: what awareness do you have of the stereo-
capacity to communicate in English. Determining the types, prejudices and racism that you hold about those
language a patient uses on a daily basis and whether they in cultural groups that are different from your own?
can speak and write in English, will indicate whether an ● Skill: what skills do you have to undertake a cultural
interpreter is needed. Family members or friends can be assessment in an appropriate and safe manner?
used as interpreters when care is being undertaken on a ● Knowledge: how knowledgeable are you about the
daily basis, although a professional or accredited inter- worldviews of the various cultural and ethnic groups
preter should be used when important information is to within your community?
be shared or when decisions need to be made. This avoids ● Encounters: what face-to-face interactions have you
the potential for family members or friends ‘censoring’ initiated with people from different cultural groups
the information conveyed during discussions. How the than yourself?
patient prefers to be addressed, cultural values and beliefs ● Desire: what is the extent of your desire to be cultur-
related to communication (e.g. eye contact, personal ally safe or competent in your nursing practice?
space or social taboos), preferences related to health care
providers (that is culture, gender or age), the nature of By critical care nurses understanding their position on
family support, and usual food and nutrition are other nursing people from other cultures, strategies can be
areas that should be explored with the patient or family, adopted to improve their responsiveness and quality of
whichever is appropriate. care delivered. Working with culturally and linguistically
diverse people should be based on the following
Given the great diversity that occurs within contemporary framework:
cultural groups, it is crucial to develop a relationship so
important cultural values, beliefs and practices can be 1. Partnership: aim to work in partnership with the
identified and incorporated into the patient’s plan of care. patient and family. Prior negative experiences may
Critical care nurses can then better understand patients’ influence the development of a productive rela-
or families’ behaviours when the patient is critically tionship. A respectful, genuine, non-judgmental
unwell. Discovering the values and beliefs patients and attitude is necessary to develop a productive rela-
their family have about health, illness, death and dying, tionship with the patient and family, and provid-
and what they believe may make their health worse, is a ing time for responses is important.
good starting point, and will provide insight into the 2. Participation: where possible the patient and
type of support and caring behaviours that may be family should be involved in their care, if this is
observed. In addition to this, identifying how health and appropriate. This will involve the critical care
illnesses are managed will provide an indication of nurse explaining the treatment and intervention
whether traditional healers are used, along with healing routines.
remedies, such as herbs and prayer for example. Also 3. Protection: involves the critical nurse determining
understanding the patient’s locus of control can also specific cultural and spiritual values, beliefs and
provide an indication of whether they will play an active practices, and enabling these to be practicsed
role in the outcome of an illness, or whether there is a during the patient’s time in the critical care unit.