Nurses Perceptions on Influences of Cultural Communication, Power Distance, and Negotiation in Pediatric Treatment Decisions

As American demographics reflect growing diversity and a changing landscape, concerns with varying perspectives of children’s and adult’s health care issues continue to arise. The western medical model expectation is that families will comply and adhere to prescribed treatments and recommendations for health promotion/disease prevention and the treatment of illness or disease. Yet, national data demonstrates that increasing uninsured, increasing poverty, increasing chronic diseases in both children and adults, and the expanding diversity in cultural and religious beliefs influencing medical and nursing care of Americans.

One of the greatest concerns affecting contemporary health care is the numbers of medical errors. Medical errors relate to both acts of commission and acts of omission. Specifically, pharmacological understanding, acquisition and adherence, dosing errors, follow-through with check-ups, can often be attributed to the communication, education, respect and perspectives of care being experienced. Influencing factors including cultural perspectives of heath care interventions, trust in the health care system, poverty and the ability to procure and manage medications, continue to be influenced by communication patterns. The goal of this project is to discover the negotiating experiences of patients and their families whose culture and religion influence treatment decisions, and then the development, implementation and evaluation of health-related curriculum on culturally sensitive negotiation skills for health care professionals. The overall aim is to make a contribution to error reduction.

Although health care program accreditation bodies require learning activities promoting effective cultural care and communication, current health care education does not expand on the development of effective skills in cultural care enough for competence in complex situations such as treatment delays, limitations or refusals.

This ethnographic investigation wove Leiningers’ (2002) theory of cultural care with the discovery of the negotiating experiences nurses have with patients, parents and health care team members as traditional medical values and expectations transect with patients’ and parents’ cultural and religious beliefs. The concept of Power Distance was found to be influential in the negotiation process. Content analysis occurred and themes representing nurses' perceptions of cultural care during difficult scenarios will be shared.