Lyu Cheng,Wen-Jiao Li,Yun Ning,Han Wang,Chang-De Jin

1Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 2School of Nursing, Tianjin University Traditional Chinese Medicine,Tianjin,China.

Abstract

Keywords:Cross-cultural nursing,Minority,Review

Introduction

The Chinese nation is an organic whole composed of 56 ethnic groups.Each of the 56 ethnic groups has its own different culture, customs and language, which leads to the cultural diversity of the Chinese nation[1].With the patient-centered and physiology-psychology-social medical model proposed,nursing staff need higher professional quality to meet the comprehensive needs of patients [2, 3].Professional nurses should pay attention to the influence of cultural factors, establish cultural awareness, understand cultural differences, master cultural characteristics, and constantly improve their ability and quality [4].Care professionals should pay attention to the influence of cultural factors in the care of patients, and set up cultural consciousness,understand cultural differences, grasp the cultural characteristics and constantly improve their own ability and the quality of cross-cultural nursing is in light of different values and life view of caregiver,cultural background and religious beliefs, etc., the caregiver all-round individualized nursing measures,to satisfy the demands of their care [5].Cross-cultural nursing theory has a wide connotation.This review focuses on the "ethnic" differences, explains the concept, advantages and application of cross-cultural nursing in teaching and clinical practice, and summarizes the special nursing needs of Tibetan and Hui ethnic groups,in order to provide a reference basis for clinical cross-cultural nursing for minority patients.

The advantages and concept of cross-cultural nursing

Cross-cultural nursing, also known as multicultural nursing, its theoretical basis is cross-cultural nursing theory.This theory was put forward by American scholar Madeleine Leininger in 1969,and he expressed,expounded and supported his conceptual framework with"sunrise mode".The aim is to provide nurses with a study and understanding of how the various components of the theory affect the health of individuals, families, groups and social institutions in different cultural contexts and to provide them with culturally consistent care based on this[6].In addition,some scholars propose to provide appropriate clinical medical treatment and nursing services according to the cultural background of the service objects, such as nationality,religious belief,nationality,world view and values, so as to achieve the best service effect[7].The ultimate goal of any cross-cultural nursing approach is to improve the quality of care and patient satisfaction.The key lies in providing culture-based care and care for the nursing objects.The use of cross-cultural nursing, understanding the cultural background of patients, will be more effective to improve the effectiveness of nurse-patient communication, is conducive to achieving the expected effect of patients,and thereby improve nursing satisfaction.Patient-centered nursing requires nursing staff to pay attention to the needs of patients.Cross-cultural nursing requires nurses to walk into the heart of patients and understand their needs, which is conducive to the establishment of nurse-patient relationship.At the same time, this theory also puts forward higher requirements on the practical ability of nursing staff to respect the needs of patients with different beliefs and world views, and practically provide cross-cultural nursing for patients in clinical practice[8].

The application of cross-cultural nursing in teaching

At present, the application of cross-cultural nursing in teaching is still in its infancy in China.Most universities carry out humanistic courses based on medical and foreign language courses to improve the professional quality of nursing students and enhance their humanistic quality at the same time.Liu N et al.[9] based on the characteristics of students'professional learning, constructed a"bilingual series of health assessment courses group", and initiated the"English-cross-cultural-professional skills" trinity bilingual teaching mode.Which its main target for foreign patients, but colleges and universities for minority patients cross-cultural nursing courses are little.Li XH et al.[10] though the investigation and analysis of the training programs or curriculum arrangements of nursing majors in six medical in Xinjiang, found that cross-cultural theory is studied from junior college to postgraduate.There are two schools to carry out folk courses, accounting for two credit hours, focusing on theoretical explanation.Xinjiang has a unique geographical location, inhabited by 55 ethnic groups.This shows the necessity of strengthening cross-cultural nursing education in Xinjiang.Wan XM et al.[11]elaborated in detail from the background, social benefits and necessity of cross-cultural nursing course setting, and pointed out that carrying out Xinjiang integrated cross-cultural nursing course is conducive to the training of nursing talents' skills, creating nursing courses with local characteristics and building a harmonious place.In general, Chinese colleges and universities do not pay enough attention to the multicultural nursing curriculum with regional ethnic characteristics, which is far from the height of systematization and standardization, which is also one of the shortcomings of the development of nursing in China.Therefore,it is suggested that nursing education should be reformed according to the cultural differences of teaching and nursing objects in the future teaching, with the guidance of cross-cultural theory, add cross-cultural nursing modules with national characteristics, improve students' cultural ability, and cultivate compound nursing talents meeting social needs.

The application of cross-cultural nursing in clinical nursing

On the one hand,cross-cultural nursing is conducive to nurse-patient communication and on the other hand, it is conducive to the rehabilitation of patients.Therefore,domestic scholars have applied cross-cultural nursing theory into clinical practice.Ma Y et al.believed that communication with minority patients was the beginning of cross-cultural nursing [12].When nurses implement cross-cultural nursing, they first need to evaluate one by one according to the sunrise model.The first layer is the world view, cultural and social structure,the second layer is the service object,and the third layer is the health care system.

According to the evaluation results to determine the nursing diagnosis, the nurse gave the patient the corresponding care.There are three main types of cross-cultural nursing care, including cultural care maintenance,cultural care adjustment and cultural care reconstruction.Wu ME et al.[13]divided the minority patients after gastroesophageal reflux disease into the control group and the intervention group, and the control group was given routine care.The intervention group was given cross-cultural nursing.Firstly, factors related to patients' culture were evaluated, such as environmental factors, dietary habits, psychological characteristics, etc., and then three modes of care were provided: cultural care maintenance, cultural care adjustment, and cultural care reconstruction.The results showed that the nursing satisfaction and nursing effect of the intervention group were better than those of the control group, indicating that the cross-cultural model could meet the nursing service needs of minority patients when applying cross-cultural nursing.This indicates that cross-cultural nursing is worth carrying out in minority patients.Wang Yapplied cross-cultural nursing combined with problem management model to the self-management behavior of hui patients with type 2 diabetes [14].The control group was given routine nursing.The intervention group applied cross-cultural nursing combined with problem management model in the basis of routine nursing.The nursing model is based on the cross-cultural nursing theory, through the discovery,analysis and definition of problems to find out the problems in patients' self-management behavior,formulate and implement the corresponding nursing.The results showed that cross-cultural nursing theory could help to find and solve culture-related problems in the self-management behavior of hui type 2 diabetes patients.The above studies all indicate the necessity and effectiveness of cross-cultural nursing in the context of multiculturalism.The diversity of social culture makes nursing staff face a variety of cultural shocks in clinical practice, which puts forward higher requirements for nursing talents in the new era.At present, although cross-cultural nursing has formed a theoretical framework, specific nursing measures have not formed a systematic and standardized norms.Based on this, Peng YQ proposed a practical plan of case management for cross-cultural nursing,formulated planning objectives for patients' problems,and implemented individualized plans and measures of cultural care preservation, adjustment and reconstruction, so as to provide patients with comprehensive physical, mental and spiritual care.She also compiled the manual for the study and application of multicultural nursing clinical nurses, which is beneficial for nurses to carry out cross-cultural nursing[15].In the nursing process, there may be cultural conflicts and communication barriers between nurses and patients, which put forward higher requirements on the cultural ability of nurses.It is necessary for nurses to strengthen the learning of multi-culture,provide sufficient respect and humanistic care, and improve their understanding and application ability of nonverbal communication.It is suggested that we should develop standards of care plan in the future,respect patients' needs, and provide minority patients with care consistent with their culture.

Some ethnic minorities in cross-cultural nursing have special nursing needs

Different ethnic minorities have different customs,cultural traditions, eating habits, religious beliefs and ways of thinking.Nursing staff should pay attention to the cultural differences among different ethnic groups when implementing cross-cultural nursing for patients of different ethnic minorities.Detailed and individualized cross-cultural nursing is conducive to promoting the nurse-patient relationship and making patients feel respect and care.The special nursing needs of Tibetan and hui nationalities are summarized as follows.

Nursing needs of Tibetan patients

Tibetan people in Tibet hate people touching their heads and shoulders [16].But nursing operations sometimes need to touch the patient's head and shoulders, so before the operation to do a good explanation.Tibetan costumes, hairstyles and headwear all have their own requirements, which are integrated into the ethnic feelings of the Tibetan people.However, clinical nursing requirements require patients to wear simple clothes,so this is also the point that nurses need to pay attention.In some Tibetan areas,women are taboo for dying patients, and some family members refuse to rescue them because of female nurses [17].Ci L et al.[18] have found that Buddha is the spiritual pillar of Tibetans.During hospitalization,Tibetan patients and their families will put scriptures and memorial articles at the head of the bed in addition to chanting sutras and rotating prayer beads every day.Patients who choose an operation date will sometimes choose an auspicious date as the operation date according to the Tibetan calendar.In terms of diet,Tibetans avoid meat of animals such as dogs, mules,horses and donkeys, and have special taboos on frogs,snakes, eels and fish [19].Tibetan people tend to have nausea when eating porridge.Nurses can provide zanba porridge instead.Nursing staff should strengthen the study of Tibetan language and knowledge of Tibetan culture, make full use of the positive elements of Tibetan culture, and pay enough respect and humanistic care to the caretakers, so as to improve the level of cross-cultural care and ensure the quality of quality care[17].

Nursing needs of Hui patients

Hui patients will still follow their "halal" diet and abstain from alcoholic drinks, pork and other products while away for medical treatment [20].Hui patients use "impermanence" and "guizhen" instead of "death",and regard talking about pigs and related products as taboo [21].During the funeral procession, the Hui people advocated to abate sorrow and believed that death was an inevitable experience of human beings.They were forbidden to howl, beat their chests, play music and other noisy sounds, otherwise it would be regarded as disrespectful and unfilial to the deceased[22].Therefore, nurses should pay attention to the language habits and avoid speaking taboo words when communicating with hui patients.The Hui people believe in Islam, as long as the physical conditions allow, Hui patients will carry out religious activities such as worship [21].Nurses should try their best to meet the needs of religious activities under the condition of the department and the patient's condition.

Summary

With the increasingly close communication between countries and people, clinical nurses are faced with more and more patients from different countries,ethnic groups and languages, so it is imperative to provide cross-cultural care.Nurses should learn and apply cross-cultural nursing theory to provide personalized care for patients of different ethnic minorities according to their cultural background and solve practical problems in clinical nursing.This review only summarizes the special nursing needs of the Tibetan and hui minorities, and fails to provide comprehensive reference for clinical workers.In view of the insufficient cross-culture nursing ability of nurses and the lack of standardized nursing system and procedures in clinical practice, it is suggested that Chinese educators and managers explore this aspect,summarize the experience and lessons of predecessors,and propose cross-cultural nursing talent training programs and standardized systems suitable for China's national conditions.In the realization of the "13th five-year plan" nursing development program,combined with cross-cultural nursing theory to cultivate high-quality nursing talents, promote the unity and cooperation between multiple ethnic groups,and jointly build a harmonious society.