The population of the U.S. is multicultural, as it consists of numerous minorities, the amount of which grows constantly. Still, the diversity is not so vivid among the nurses. Thus, they are to care of the representatives of various cultures different from theirs. As currently this issue attracted the attention of a number of specialists, the author targeted at the evaluation of their works. She wanted to sum up the information gained from the studies and provide decent considerations for the professionals to utilize them in their work. In other words, the purpose of the article is to examine previous qualitative researchers connected with the cultural gap using meta-synthesis. Coffman questions the preparedness of the nurses to deal with the increasingly multicultural patient. Such concerns occur because the specialists are to satisfy the needs of the consumers, and it cannot be properly done if they do not understand and consider cultural peculiarities. To be more precise, the author concentrates on:
- Connection with the patient – what is the way the nurses communicate with their clients?
- Cultural understanding – what do the nurses know about the peculiarities of their patients’ culture?
- Consumers within the family framework – what influence do the relatives have on the clients’ health and care?
- Culturally sensitive care – do the nurses realize the importance of meeting cultural needs of their patients?
- Socioeconomic status – how is the socioeconomic diversity connected with culture and in what way does it influence healthcare?
- Non-judgmental attitude – do the biases influence care for the patients?
The sample used in the research occurred to be a number of articles (13 items) that discussed the nurses’ experiences in delivering health care to the patients from different cultures.
In the study, Coffman evaluated qualitative researches through the meta-synthesis. In particular, a meta-ethnographic comparative method was utilized by the author. It is connected with both ethnography and interpretation, which means that the issue was analyzed regarding cultural peculiarities and explained at the same time. This process was conducted in seven steps:
- selecting the topic of the future research;
- locating a sample;
- searching for the literature and conducting a review;
- finding out the relation between ideas and concepts;
- comparing and contrasting the sources;
- clustering the data together;
- finalizing the findings.
The literature chosen for the research included the articles that were dealing with the similar issues and could be compared. From the very beginning, there were two inclusion criteria: the study was to be concentrated on the health care providers who deal with clients from various cultures, and it was to be qualitative. Thus, several databases were used to find appropriate articles, including Medline and ERIC. Keywords used in the literature search were: “culture, cultural bias, minority, cultural competence, experiences, as well as providers, nurses, clinicians, physicians, therapists, health care professionals and socials workers” (Coffman, 2004, p. 100). Initially, the author selected 18 articles to use them in the research. But then the exclusion criteria were chosen. They were the health care providers (only nurses), the methods used (observation was not enough), location (only the U.S.), number of participants (from 7 to 767), information about the ethnicity (regarding both patients and nurses), study settings (“hospitals, clinics and community health settings”) (Coffman, 2004, p. 101).
The quantitative data gained from the articles while comparing them was presented in tables to be easily perceived and interpreted. They included the key “metaphors, phrases, idea, themes and concepts” (Coffman, 2004, p. 100). While working with the main themes mentioned in the articles, the author gathered them identifying whether they can be compared directly or need to be contrasted due to the range of distinctions. Initially, Coffman identified more than 10 categories but then used only 6 and integrated them into the table. These were
- connecting with the client
- cultural discovery
- the patient in context
- in their world, not mine
- road blocks
- the cultural lens” (Coffman, 2004, p. 100).
Thus, the methodology used by the author allowed her to answer all settled questions and occurred to be appropriate for the research purpose. It was consistent with the stated study design. The information was gained and examined in an iterative, interpretive way, as the same points were considered dealing with each article and thoroughly described and evaluated (it can be seen in the tables and description of the findings). Coffman referred to more than 20 sources to support her ideas, including the articles used as a sample. They all are authoritative and were current. The data collection methods provided the author with the opportunity to produce the explanation of the issues and their context as well as to provide implications for practice. It was achieved by dint of limiting the framework of research to the adequate amount of information, which was deeply investigated. The author defined the points considered in all articles to gain more authoritative data while comparing them. She also referred to the experience of nurses and students to evaluate the issue in etic perspective. The meaningful summary presented by Coffman proves her understanding of the researches and supports the validity of implications for practice. To my mind, there were no gaps in the data and its collection, as the author provided the limits that made it possible to manage a complete study. Thus, the points that seemed to be omitted turned out to not be taken into consideration initially (which just underline the possibility of further research).
To control her biases and preconceptions, Coffman supported each claim with the information taken from the other sources. She introduced her idea and provided an example from the articles to prove the point of view. The researcher also referred to other sources, such as nursing statistics and demographic profiles.
It was found out that the nurses often considered cultural differences and language barriers to be a big issue that impacted the delivery of health care due to the lack of understanding. Still, not all of them were ready and really wanted to learn more about the peculiarities of other cultures. Realizing the connection of the patient with his/her family, nurses found out that they can guide the relatives to improve health outcomes. They also pointed out that treating patient’s religious rituals and beliefs with respect enhanced their communication and influenced care. Nurses also underlined that many patients who were representatives of minorities occurred to be not able to pay for the treatment and often asked to continue with home remedies. They also admitted that they had treated the patients through the stereotypes. In the report, the data is presented in several ways, including tables, direct and indirect quotations and justifies emerging themes. The author made some of these claims but always supported them with the information from the sources, which can be seen in the body of the paper. To confirm the finding Coffman included the quote from another study.
The findings are useful in providing insight or guidance to the nurse caring for a patient, which can be proved by implications for practice. The author enumerated the main issues faced by the nurses and suggested several ways that can be utilized by the professionals to enhance their cultural competence.
The main study limitations included “the diversity of the participants sampled and the wide variety of cultural groups that they care for” (Coffman, 2004, p. 104). It turned out to be a cause of why the variety of experiences were examined and also made the process of comparison more complicated. The limitations also included the number of the articles used as a sample and the issues under investigation.
Further researches are suggested by the author to examine more narrow topics. Coffman (2004) claims that “separate meta-synthesis could be conducted related to specific practice settings, cultural groups and practice concerns, in addition, further qualitative studies are needed not just on the experience of nurses and nursing students caring for patient from other cultures, but on that of others who work within the health care system” (p. 101).
Personally I believe this study to be authoritative and well-grounded. It is useful for the nurses and student nurses, as it provides them with the opportunity find out how the culture affects the health care delivery. I understood that the cultural differences may become a great problem for nurses and patients, as they cause misunderstanding. Knowing all peculiarities, I can prevent future issues by learning the information about other cultures and utilizing it while caring for the clients.
Annotated bibliography
Coffman, M. (2004). Cultural caring in nursing practice: A meta-synthesis of qualitative research. Journal of Cultural Diversity, 11(3), 100-109.
The study conducted by Maren Coffman was published in a peer-reviewed journal. The researcher wanted to understand the meanings derived from the nurses’ experience of taking care for patients who belong to other cultures.