A University of Johannesburg (UJ) study has developed a model aimed at helping nurses provide culturally sensitive care to children in hospital, with mothers and primary caregivers playing a central role in the process.
The model was developed by University of Johannesburg department of nursing researchers 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 research, published in Curationis in August, focuses on the experiences of professional nurses and mothers of children admitted to a children’s hospital in Gauteng.
The researchers say children’s healthcare experiences can be influenced by their cultural beliefs, family practices and developmental needs.
They 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.
“This is not about doing things differently for the sake of culture,” the study’s approach suggests. Instead, it is about creating a process in which nurses and families can communicate about cultural expectations while ensuring that the child receives appropriate medical care.
One of the examples used by Mngomezulu 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. If the baby is dehydrated and the veins in the arms have collapsed, the only accessible vein may be on the baby’s head.
In such a situation, the baby’s head may need to be shaved to allow the drip to be inserted. For a mother from a culture in which a baby’s first hair carries cultural or spiritual significance, however, finding her baby’s head shaved and the hair discarded could be deeply upsetting if she had not been told beforehand.
The researchers use the example to highlight the importance of communication rather than to suggest that necessary medical treatment should be withheld.
Mngomezulu and Downing say culturally sensitive nursing requires healthcare workers to consider the child within the context of their family and community.
The study is grounded partly in the philosophy of Ubuntu, which the researchers describe as emphasising shared humanity, respect, dignity and interconnectedness.
“Caring” is therefore presented as more than addressing a patient’s physical condition.
The model places the child at the centre of care, while recognising the mother or family as an important part of the child’s healthcare journey.
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.
Two main issues
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 researchers also found that nurses themselves experienced uncertainty. One nurse said healthcare workers needed to understand that their cultural beliefs were not necessarily the same as those of the parents they were treating.
Another said there was a need for education because nurses, managers and doctors might not understand certain cultural practices.
The proposed model is designed to provide a structure for navigating that uncertainty.
It 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. At this stage, the nurse initiates communication with the child and mother or primary caregiver, establishes trust and asks about cultural care expectations.
The researchers say nurses should also reflect on their own cultural values and beliefs to become aware of possible biases that could affect the care they provide.
The working phase corresponds with the child’s hospital stay. During this period, the nurse is expected to engage more deeply with the child and mother, learn about their cultural beliefs and healthcare expectations and incorporate relevant information into the care plan.
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 final stage is the termination phase, which corresponds with discharge. The child and mother reflect on the care they received and provide feedback, while the nurse reflects on their confidence and ability to provide culturally sensitive care.
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 said the feedback indicated high levels of clarity and perceived importance, while suggestions were made to improve its accessibility and universality.
The researchers say the model could potentially be applied beyond South Africa, although its effectiveness in other settings would still need to be established.
For now, however, the model has not been implemented in hospitals.
Guidelines
Mngomezulu and Downing said the guidelines for implementation had been developed, but further research was needed to test the model in practice.
The study also has limitations. It was conducted at only one children’s hospital and included professional nurses but excluded enrolled nurses and enrolled nursing assistants.
The researchers say the experiences of these other nursing categories have not yet been explored.
They also acknowledge that the experiences of nurses and mothers at other hospitals with paediatric units were not included.
The researchers recommend future studies involving other categories of nurses, more hospitals and the practical implementation of the model.
The researchers ultimately argue that culturally sensitive care could help build greater trust between healthcare workers and families.
The study concludes that misunderstood and unmet cultural expectations remain a challenge in caring for hospitalised children and that the proposed model offers a practical framework for addressing those challenges.
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