Notes taken and webplaced by Ian Hodgson on 26th October 1998

Please click on names below to go to appropriate section:

• Session 1 - Nola Ishmael - Nursing Officer for Ethnic Minorities, DoH
• Session 2 - Kate Gerrish – Senior Research Fellow in Nursing, Sheffield Hallam University
• Session 3 - Transcultural mental health issues (workshop)
• Session 4 - Sarah Guthries – Cultural Liaison Officer, City Hospital NHS Trust, Birmingham
• Session 5 - Irena Papadopoulos – Director of Research Centre for Transcultural Studies in Health, School of Health, University of Middlesex

Session 1  - Nola Ishmael – Nursing Officer for Ethnic Minorities, Department of Health

Introduction - - The post of NOEM is important, and contributes towards policy making with regard to all areas of health, including CHD and stroke; social exclusion; inequalities in health; ethnic minorities; and accidents.

Transcultural issues are essentially multi-dimensional, and ethnic cultures within the UK are extremely diverse (many more ships came across than just the MV Windrush !). The DoH aims to reduce inequality and avoidable disease/injury, and generally improve services.

How can culture be defined ? as a complex set of values, beliefs, knowledge, laws, custom, habits, considerations, and all influences acquired by a society, an agreed way of perceiving the world, language, geographical description, individual identity.

Culture is manifested in: routines, diet, communication, language, sense of continuity (past, present and evolving – a blueprint for the future.

What is the government doing ? The NHS is a large state run conglomerate – 6.6% of employees are of black or ethnic origin (though only 5% of the general population). Thus, personnel issues are a priority within the NHS.

Future developments that will have a direct impact on cultural issues include – health improvement programmes; commitment to modernisation; less change but more modernisation (key New Labour phrase !); creation of ‘NHS Direct’, a central database that can be reached by telephone; clinical governance; health action zones; human resource strategy.

• Implementation of ‘social exclusion unit’, headed by the PM; also further development of health action zones, which are designed to provide local solutions to deep seated problems, in collaboration and partnership with local organisations.

• Primary care groups - ‘Healthier Nation’ aims to improve health and address inequalities among all people through ventures like ‘joined up working’, in which community action can result in combined efforts to improve health. PCGs should enable receipt of care at a point convenient to them, and need a uniformity of standard, set not by us (the professionals), but by the patients (the users). Therefore, the PCGs decide on the health needs of the community, and decide how the health needs can be met. The PCGs will work with the social services etc. to ensure integration of services.

• National contracts for health – designed to recognise contribution of all groups, eg. Dept of the Environment, schools, business, political organisations. Health is therefore no lnger a unilateral pursuit, but rather a shared responsibility.

What is the DoH specifically doing about black and ethnic issues ?

Objective is to get ethnic health issues into the mainstream debates about health care. Competencies need to be set in order to address cultural issues.

DoH is looking at personnel issues, and Jeff Chandra (? where) has developed a toolkit to be used by trusts and Health Authorities – eg. multi-lingual signposting around hospitals, diet, communication etc.

What are the future challenges ?

• ageing black and ethnic population (triple jeopardy)
• future isn’t orange, but multi-cultural (yes, it was a joke)

Session 2 - Kate Gerrish – Senior Research Fellow in Nursing, Sheffield Hallam University - Kate Gerrish – Senior Research Fellow in Nursing, Sheffield Hallam University

Responding to Cultural Diversity (report of research) – the challenge to education

1. Overview of 2 studies.

• ENB project – examining curricula and preparation of practitioner in relation to cultural issues. Examined content of courses, using postal survey (nationally) and case studies of 3 institutions to follow up. Also, interviewed service users (included all forms of culture – ie. Irish, Polish, Sikh, Muslim etc.).
• Doctoral study – examination of nursing practice and provision of individualised care, and how this links to policy. Utilised ethnographic method and researcher worked in 6 district nurse teams caring for black and ethnic minority patients.

2. Challenge for nurse education - from various perspectives.

Service user’s perspective - issues included: language; the need for a recognition and meeting cultural needs; the accessing of appropriate services by minority groups (and making sure the person knows what is available); respect and recognition of differences – ignorance of culture among nurses was a common feature identified in the study.

Practitioner’s perspective Practitioner’s perspective - issues included: varying degree of confidence; structural constraints (eg. day care services not being culturally responsive); lack of knowledge.

3. Agenda for action and required curriculum developments

Need to respond to ethnic diversity, and respond to health disadvantage and discrimination among ethnic minorities.

• need to introduce cultural awareness (and encourage and awareness of one’s own culture
• develop specific knowledge and competence
• apply specific cultural concepts to practitioner-client encounters, and encourage the student to understand the patient’s perception
• develop and understanding of socio-economic and political infuences (a critical examination of health care delivery and ethno-centric practices)

Problem – all ‘minority’ groups need addressing – eg. Eastern European countries – and a challenge to prejudice, discrimination and inequalities

Other issues included: teacher feeling ill prepared ; certain patients making racist comments about other patients

4. Partnerships with the local community

• in course delivery
• in curriculum development and evaluation

5. Partnerships with service

• education agenda needs top be influenced by service agenda
• continuing education for practitioners is a necessity
• recruitment of increasing numbers of black and ethnic minorities into the nursing profession

Session 3 - Transcultural mental health issues (workshop) Session 3 - Transcultural mental health issues (workshop)

• Afro-Caribbeans have increased rates of admission to psychiatric hospitals
• They are more likely to be diagnosed as schizophrenic
• People in this group are less likely to have been in prior contact with their GP, and more likely to have been referred by the police and detained in a ‘place of safety’

• Most books on cultural health written by white Europeans
• African and ethnic minorities are constantly being ‘researched’
• Prejudice has been internalised, and perpetuators and victims both accept the status quo
• Diagnosis is a medical role, and therefore the affect of transcultural nursing may be limited in certain fields – some work (eg. Rolnd Littlewood at UCL) is addressing this (regarding schizophrenia), though this may be too little too late

• Need more forums for discussion
• A sharing of expertise
• Partnerships
• Link to people who can influence change

Session 4 - Sarah Guthries – Cultural Liaison Officer, City Hospital NHS Trust, Birmingham - Sarah Guthries – Cultural Liaison Officer, City Hospital NHS Trust, Birmingham

The Role of the Cultural Liaison Officer

Key initiatives included:

• development of phonetic phrasebook (for Hindi)
• Asian ‘pyjamas’
• Pictorial menu cards
• Policy on black and ethnic groups
• Cultural competence and anti-discriminatory courses
• Addressing issues of confidentiality and development of a code of conduct for interpreters

Session 5 - Irena Papadopoulos – Director of Research Centre for Transcultural Studies in Health, School of Health, University of Middlesex - Irena Papadopoulos – Director of Research Centre for Transcultural Studies in Health, School of Health, University of Middlesex

Introduction to Transcultural Studies European Network and the mailing list.

Concept of transcultural nursing evolved in US by Leinenger and her colleagues. The very American approach has been criticised by Europeans, including Finnish nurses, who suggest that issues relating to racism, class and socio-political aspects should be considered.

Thus, the European approach to transcultural nursing is distinct, and the mailing list (details below) is one way of addressing this. Currently, there are 70 people on the list throughout Europe – the list is free of charge and not moderated.

Initial teething problems included: low level of participation, and people replying to individuals and not groups.

Also, check out the Research Centre for Transcultural Health, Middlesex University, at:

http://www.mdx.ac.uk/www/hebes/centres/rctsh.htm

And also the European Electronic mailbase to stimulate dialogue and exchange of transcultrual inforamtion.

To subscribe, send the message (with this text only):

subscribe transcultural-eunet-l

To this address:

Mailserv@mdx.ac.uk

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