Researchers at the University of Johannesburg have developed a model aimed at helping nurses provide culturally sensitive care to children in hospital. The model was developed by Dr Catherine Mngomezulu and Prof Charlene Downing after they found that cultural misunderstandings between nurses and families can create tension around the care of sick children. The study focuses on the experiences of professional nurses and mothers of children admitted to a children’s hospital in Gauteng.
The research, published in Curationis in August, highlights the importance of cultural sensitivity in healthcare. The researchers argue that while nurses are expected to provide culturally sensitive care, they may not always have clear guidelines to help them navigate cultural differences in clinical settings. The study uses the philosophy of Ubuntu, which emphasises shared humanity, respect, dignity and interconnectedness. This approach prioritises communication between nurses and families to ensure that the child receives appropriate medical care.
One example used by the researchers illustrates how a seemingly routine medical intervention can become a source of distress for a family. A newborn admitted to a neonatal unit with jaundice may require an intravenous drip, which may need to be inserted into a vein on the baby’s head. For a mother from a culture in which a baby’s first hair carries cultural or spiritual significance, finding her baby’s head shaved and the hair discarded could be deeply upsetting if she had not been told beforehand.
The researchers interviewed 12 professional nurses and seven mothers of children admitted to the children’s hospital. The participants came from different cultural backgrounds. The interviews explored their experiences of culturally sensitive nursing care and their understanding of culture. The nurses identified three main issues: tension between professional responsibility and cultural sensitivity, misunderstood expectations and the need for greater awareness and formal guidelines on acceptable cultural practices.
The mothers identified two main issues: the disregard of certain cultural practices and cultural misunderstandings. One mother said she felt that the way some practices were handled took away her right to care for her child in the way she believed was appropriate. Another participant described situations in which she felt healthcare workers did not take her religious beliefs seriously, even when they did not directly act against her wishes.
The proposed model divides the child’s hospital journey into three phases: the relationship phase, the working phase and the termination phase. The relationship phase corresponds with admission, where the nurse initiates communication with the child and mother or primary caregiver, establishes trust and asks about cultural care expectations. The model also calls for nurses to use available resources, including institutional policies and guidelines, seek additional training and involve other members of the multidisciplinary team when necessary.
The model was evaluated by seven nursing theory experts with experience in qualitative research and knowledge generation. The experts assessed it according to five areas: clarity, simplicity, generality, accessibility and importance. The researchers say the feedback indicated high levels of clarity and perceived importance, while suggestions were made to improve its accessibility and universality. The model could potentially be applied beyond South Africa, although its effectiveness in other settings would still need to be established.
Key points
- The study's approach, grounded in Ubuntu philosophy, prioritises communication between nurses and families to ensure culturally sensitive care for children.
- The proposed model provides a structure for navigating cultural uncertainty in clinical settings, dividing the child's hospital journey into three phases.
- The researchers recommend future studies involving other categories of nurses, more hospitals and the practical implementation of the model.
