Transcultural Nursing in Australia

Australia is a multicultural society. The 2016 Census revealed that over a quarter of the population was born overseas, and 45.5% of people have at least one overseas-born parent (ABS 2016).

Birthplace of parents, stated responses	Australia	%	2011	%
Both parents born overseas	8,051,196	34.4	6,876,585	32.0
Father only born overseas	1,488,092	6.4	1,407,270	6.5
Mother only born overseas	1,094,591	4.7	989,219	4.6
Both parents born in Australia	11,070,538	47.3	10,757,087	50.0

(ABS 2016)

In Australia, 47.3% of people had both parents born in Australia and 34.4% of people had both parents born overseas (ABS 2016).

Furthermore, 17.9% of Australians were born in a non-English speaking country (PHIDU 2016). This multiculturalism has a huge impact on many aspects of society, but especially on the healthcare system.

Transcultural nursing seeks to provide care that acknowledges an individual’s culture, values, beliefs and practices – the crux of which is good communication between the health professional and the patient and their family.

Read: Communication Skills

Health professionals need to deliver culturally-appropriate, culturally-sensitive care; an undertaking that is sometimes difficult due to the cultural and ethnic diversity within our society.

Transcultural Nursing

As health professionals living in a multicultural society, it would be unusual for us not to have come across a patient who is culturally and ethnically different from ourselves. Sometimes we can cross the barrier with ease, recognising the core values and beliefs of our patient and working with these.

At other times the barrier is harder, or even impossible, to cross. Communication difficulties arise - even when a translator is available, non-verbal messages may be missed by the patient, or even by the health professional.

Narayanasamy developed the ACCESS model in order to help health professionals bridge the cultural gap and provide acceptable transcultural care:

• Assessment – focus on cultural aspects of client’s lifestyle, health beliefs, and health practices;
• Communication – be aware of variations in verbal and non-verbal responses;
• Cultural negotiation and compromise – become more aware of aspects of other people’s culture as well as understanding client’s views and explaining their problems;
• Establishing respect and rapport – a therapeutic relationship that portrays genuine respect for client’s cultural beliefs and values is required;
• Sensitivity – deliver culturally-sensitive care to a culturally diverse group; and
• Safety – enable clients to derive a sense of cultural safety.

(2002)

It is always important to remember that just because a person looks different to ourselves, or even identifies with a different culture, they are still an individual. Their values, beliefs and practices may be the same as our own, or completely different. It is up to us to establish these similarities or differences and acknowledge these in the way we treat our patients.

Transcultural Care in Practice – Potential Scenarios

Theories and models are all very well, but putting them into practice can be challenging. How would you respond to the following situations?

• The family of an Asian patient insist on rubbing him with a coin, hard enough to bring up bright red welts, as a form of treatment.
• A Middle-Eastern patient on strict bed rest attempts to get out of bed in order to pray facing towards Mecca.
• A Chinese patient refuses pain medication after surgery (his cultural belief being that it is impolite to accept something the first time it is offered).
• The family of a newborn baby hang a knife over its crib in order to 'ward off evil spirits'.

Although we, as health professionals, constantly strive to provide sensitive, compassionate care, there is no doubt we may find ourselves in situations that challenge us. Although we don’t need to have a comprehensive understanding of the cultural and ethnic norms of all those who live in our society, we do need to make an effort to communicate with our patients and understand their needs in order to provide appropriate transcultural care.

The following websites provide further reading and resources: Transcultural Nursing and Making Multicultural Australia. If you know of additional resource or services that may help other readers, please leave a note in the comments section below and they will be considered for inclusion in the article above.

Additional Resources

• Making Multicultural Australia
• Cultural Competence and Patient Safety - ABCD for Cultural Assessment
• Cultural Considerations in Healthcare

References

• Australian Bureau of Statistics 2016, 2016 Census QuickStats, ABS, viewed 15 October 2020, https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/036
• Narayanasamy, A 2002, ‘The ACCESS Model: A Transcultural Nursing Practice Framework’, British Journal of Nursing, vol. 11, no. 9, pp. 643-50, viewed 15 October 2020, https://pubmed.ncbi.nlm.nih.gov/12048479/
• Public Health Information Development Unit 2016, People Born in Predominantly Non-English Speaking Countries, 2016, Torrens University, viewed 15 October 2020, http://phidu.torrens.edu.au/notes-on-the-data/demographic-social/nes-countries#:~:text=Policy%20context%3A%20In%20the%202016,%2DEnglish%20speaking%20%5B1%5D.