The needs of migrant patients
By Heidi Heinhold
In hospitals all over the world people of very diverse cultural backgrounds come together, whether as employees in various roles, or as patients. This means that hospital teams must deal with diverse needs, cultures and languages.
In 1963, Virginia Henderson in the US determined the 15 basic human needs in her Theory of Basic Principles of Nursing Care. These are internationally acknowledged as the lowest common denominator for patient care. Nurses are responsible for the basic needs of patients, which include rest and sleep, cleanliness and personal hygiene, the expression of emotions, distress, and their fear or feelings about dealing with others.
Transcultural nursing care
About 10 years ago Renate Pförtner-Hüttner*, then a nurse at the Nuremburg Hospital, examined the situation regarding foreign hospital patients as part of her Professional Care training course.
l Expectations: It transpired that these patients did not expect or demand that the staff should know much about their cultures – expectations were very low. Patients from Eastern Europe and Turkey consciously tried to assimilate into the daily life on the wards without any problems.
l Religious needs: Patients accept a hospital’s particular organisation and adapt their individual needs
to those expectations. However, Muslim patients did state that they missed a room where they could carry out their religious rituals, particularly cleansing before prayer, which should always be carried out with running water. This, however, is not possible for bedridden patients. There is one comfort – Islam permits making up for missed prayers at a later time.
l Religious diet: Patients were not worried about something as obvious as mistakenly being served pork. However, they were concerned about whether, in a large hospital kitchen, there was sufficient care to keep different foods apart, e.g. in the preparation of sauces. Some patients preferred to use their own cutlery and crockery to avoid possible contamination.
l Language barriers: There were fewer than assumed and these mostly occurred among Muslim women whose lives were focused around their families and who only communicated in their mother tongue.
l The generation gap: Muslim patients of the so-called first generation were a lot less forthcoming with their wishes and demands than those of the second generation. Younger patients were very well informed about their rights and opportunities in a hospital.
To summarise: It could be said that foreign patients acknowledge the singular situation they are in and so put their individual needs on hold.
Are foreign patients ill in a different way?
Twenty years ago the German Red Cross examined this question in their project: Older migrants – the promotion of social commitment by younger people to help older, foreign fellow citizens in Germany.
62.1% of men and women polled stated that they felt sick rather than healthy, whereas 37.9% reported that they felt their current physical state was good. The most common complaints were headaches, back and joint pains, circulation problems, cardiac trouble, nervousness and other ailments, such as bronchial infections and ulcers (in stomach, duodenum, which can have psychosomatic elements).
Working practices in western industrial nations, e.g. working in large scale industries, industrial production, shift work etc. were identified as contributors to the development of illnesses. These practices are very different to the way that people had previously worked in their own countries, where they may have been agricultural workers, craftsmen or traders, leading to premature deterioration of health, high occurrence of sickness, increasing numbers retiring early due to ill health, occupational diseases and problems after occupational accidents.
Conclusion: In- and out-patient nurses cannot solve the issues alone. Apart from voluntary training, they need professional support from reliable individuals who mediate between the hospital and the patients. Many problems are unlikely to be solved, particularly as in-patient stays are increasingly shorter; for other problems that occur consistently and repeatedly (e.g. the need for a room for religious rituals) in time there will be a solution acceptable to all.
*Source: Pförtner-Hüttner, Renate: Study on the care of foreign patients: How important are cultural differences. Pflegezeitschrift 1/99 59-61, Kohlhammer, Stuttgart
01.09.2008
