The Mother-Friendly Childbirth Initiative
References for Mother-Friendly Childbirth Initiative Step 3:
Provides culturally competent care
(Links are to abstracts of the papers below)
- Gaffney, K., Choi, E., Yi, K., Jones, G., Bowman, C., and Tavangar, N. (1997). Stressful events among pregnant Salvadoran women: A cross-cultural comparison. Journal of Obstetric, Gynecological, and Neonatal Nursing, 26 (3), 303-310.
- Howard, J., and Berbiglia, V. (1997) Caring for childbearing Korean women. Journal of Obstetric, Gynecological, and Neonatal Nursing, 26 (6), 665-671.
- Weber, S. (1996). Cultural aspects of pain in childbearing women. Journal of Obstetric, Gynecological, and Neonatal Nursing, 25 (1), 67-72.
- Sweeney, M., & Guilino, C. (1987). The Health Belief Model as an explanation for breastfeeding practices in Hispanic population. Advanced Nursing Science, 9 (4), 35-50.
Summary/Commentary:
These articles support and foster the need for care providers to become culturally sensitive within their practices. The importance of providing culturally-sensitive care is well addressed in these articles. They offer the health care community a beginning knowledge base on which to start practicing culturally-sensitive care. The March of Dimes produces more extensive materials on this subject.
Reference Abstracts:
- Gaffney, K., Choi, E., Yi, K., Jones, G., Bowman, C., and Tavangar, N. (1997). Stressful events among pregnant Salvadoran women: A cross-cultural comparison. Journal of Obstetric, Gynecological, and Neonatal Nursing, 26 (3), 303-310.
Major Premise: Health care must augment care within a cultural system and give recognition to the importance of the support provided by that cultural system.
Research Question: Do maternal and infant health risk factors in relation to stressful events differ within the ethnic subgroups of the Hispanic population; and, how do episodes of violence and alcohol or drug use compare within these groups and the non Hispanic, low income population in the United States?
Study Design: A comparative, descriptive study was performed at public health prenatal clinics utilizing the Difficult Life Circumstance (DLC) scale and psychosocial history assessment.
Subjects: The population of pregnant women representative of the three groups being compared consisted of: 104 Salvadorans; 69 non-Salvadoran Hispanics; and, 187 non-Hispanics.
Findings: Analysis of statistical group differences supported no significant differences noted between Salvadoran Hispanics and other Hispanics. The occurrence of stressful events, alcohol and drug use, violence, and stressful events was more prevalent in the non-Hispanic cultural group. The Hispanic low income subjects were mostly first generation immigrants. It was conjectured that first generation women may be protected from the effect of daily stresses by frequent contact with other women of their culture who create supportive communities to support and affirm vulnerable women. Health care should augment these cultural systems and provide care within their context.
Research reviewed by Roxanne Zeto-Brennan, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Howard, J., and Berbiglia, V. (1997) Caring for childbearing Korean women. Journal of Obstetric, Gynecological, and Neonatal Nursing, 26 (6), 665-671).
Premise: An understanding of the cultural elements that may influence the health behaviors of childbearing Korean women provides nursing with the knowledge base needed to individualize and implement appropriate, culturally-sensitive care that can foster optimum health outcomes.
Research Question: What are the relevant cultural beliefs and traditions embraced by some childbearing Korean women that nursing needs to acknowledge and understand before the best, culturally-sensitive nursing care can be offered?
Research Design: A combination methodology of historical, phenomenological, and ethnographic studies were reviewed in obtaining data to effectively answer the research question.
Findings: This study noted that many Korean women follow a "cultural prescription" of rituals and practices that guide their safety during the childbearing years. Do's and don'ts when interviewing and assessing pregnant Korean women in order to acknowledge, understand, and respect the cultural beliefs and traditions influencing her harmony, balance, and well-being are:
1) Some Koreans expect a physician to diagnose from history without a physical exam.
2) Some Koreans respect authority in health care providers to the extent that they may interpret being offered choices as incompetence of the provider.
3) Many Koreans use both American biomedical systems and Korean traditional medicine but may not tell this to an American provider for fear of ridicule.
4) Modesty and stoic response to pain are common values influencing pregnancy and labor care.
5) 51% of mothers in a 1987 study in Korea were found to believe in taekyo, a system of pregnancy rituals and taboos.
6) Avoidance of a large fetus at delivery may be achieved by use of a tight binder at 20 weeks and/or hard physical work in late pregnancy.
7) Many position options are expected in labor and the role of the obstetric care provider is more like a mental guide.
8) The husband or elderly woman in the family may make the health-related decisions.
9) A Korean may expect to rest for 21 days after birth.
10) Visitors are often restricted in the postpartum period.
11) Writing a name in red ink is reserved for the dead.
12) Yes, when told to a care provider may mean yes I will, or it may mean I heard, or I understand.
Research reviewed by Roxanne Zeto-Brennan, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Weber, S. (1996). Cultural aspects of pain in childbearing women. Journal of Obstetric, Gynecological, and Neonatal Nursing, 25 (1), 67-72.
Major Premise: The cultural beliefs and traditions held by childbearing women may influence their perception and expression of pain and discomfort experienced during labor and postpartum periods.
Research Question: What are some of the ethnic and cultural elements that may influence a woman's pain experience; and, how does transcultural knowledge foster optimum management of pain and discomfort experienced in women during labor and postpartum periods?
Study Design: The study is based on a literature review of 20 references including oral accounts of 2 relevant nursing lectures on cultural diversity's importance in delivering quality nursing care. Literature reviewed noted both quantitative and qualitative design studies utilized, such as; true experimental; quasi-experimental; comparative; phenomenological; ethnographic; grounded theory; and, case studies.
Findings: Consistent documentation of empirical data validates that ethnicity and culture do play a role in how a woman perceives, expresses, and experiences pain during childbirth.
Problems sometimes develop with care providers because:
1) Verbal communications related to cultural differences are impaired.
2) Social dissonance or lack of common understanding leads to impaired social interaction or interpretation.
3) Differences in the mother's value system about health beliefs may create conflict with care provider assumptions.
Indepth cultural assessment can use tools such as the Leininger Assessment, the Tripp Reimer Assessment, or the Andrews Assessment. Emergency cultural assessments should include details about nationality, language, religion, and expectations about care.
Non-verbal communication becomes increasingly important when verbal communication is impaired. This can consist of using warmth and respect, soothing touch when accepted, and simple idiom-free language. Care providers should study transcultural key concepts for cultures they frequently encounter, respect them, and make allowances for cultural differences. Interpretations and written materials should be made available to the clientele.
Research reviewed by Roxanne Zeto-Brennan, RN, student at Virginia Commonwealth University, School of ng, Richmond, VA.
- Sweeney, M., & Guilino, C. (1987). The Health Belief Model as an explanation for breastfeeding practices in a Hispanic population. Advanced Nursing Science, 9 (4), 35-50.
Premise: Hispanic immigrants have a unique set of health beliefs that influence their breastfeeding decisions.
Variables: Prenatal care obtained, individual perception.
Data Collection: 140 women of Mexican/American descent were selected in four hospitals. The women were an average of 21 years of age and primiparous. The women were interviewed at 24 hours postpartum and six weeks postpartum. All questions were read aloud to the subjects to eliminate any potential for error with reading difficulty.
Findings: The Hispanic's health seeking behavior is different than the Anglo-American's. The care provider may be used, however, the information received is mediated differently. In the Hispanic culture, family members and friends are a strong influence on how the woman makes decisions about breastfeeding. The use of Pender's modification of the Health Belief Model is useful in predicting motivational factors that affect breastfeeding. These include individual perceptions (prenatal care obtained and reason for selecting the feeding method), modifying factors (maternal age and head of household), and likelihood of action (timing of the breastfeeding decision and father's opinion). As families immigrate they form a unique culture that is unlike either that of Mexicans or Anglo-Americans. Health professionals need to understand these influences on their breastfeeding decisions.
Research reviewed by Eliane Petros, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.