The purpose of this ethnographic research was to capture the experiences of practicing acute care nurses who work in the San Francisco Bay Area where health care enviornments are richly diverse. The aim of the study was to discover how practicing nurses communicate and negotiate with culturally diverse patients and families. Specifically, the purpose was to discover how nurses navigate through difficult clinical scenarios where families may experience power distance (the feelings of inequality or the extent in which people accept that inequality exitis in society) that lead to misunderstandings, lack of full disclosure and ultimately the refusal, delay or limitation of medical treatment, or the development of medical or medication errors.
Methods:
Ethnographic methodology was used via in-depth interviews of unlimited lenth. Interviews were audio-taped and transcribed for content analysis and thematic identification.
Results:
Demographics demonstrated the mean age of participants was 53 years, and mean years in nursing practice was 25.8 years. Participants were culturally diverse with Asican, Hispanic, African American and Caucasion decent. Emic extractions, induction processes and empirical formulations (Leininger, 1985) were used to help make connections and identify perceptions, knowledge and language in terms of how people perceived and interpreted their experiences. Based on 33 interviews, the researchers found that power distance contributes to the development of errors. Analysis of the participants' narratives and responses included three major themes: 1)power distance creates barriers to effective communication; 2)understanding the impact of strained communication contributes to errors; and 3)nursing education woefully prepares nurses to assist ethnically and culturally diverse families during difficulty clinical scenarios when trust and feelings of inequality interfere with effective and safe care.
Conclusion:
Nurses who work with culturally diverse interdisciplinary teams and culturally diverse patients and families must understand that power distance creates barriers to safe care. Cultural perspectives and care practices may not be disclosed to health care providers if patients or their families feel threatened, misunderstood or disrespected. Medical and medication errors can occur if power distance is not identified and families feel supported and listened to. The study has several implications related to practice and eduction. After analysis, the research team came to consensus that teaching the impact of the role of power distance new nurses is a directive, teaching how individualism/collectivism influences care and communication, and identifying early for the avoidance of potential errors related to strained cultural communication is important in all settings.