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Treatment pathways must take account of cultural beliefs

Some communities may be hard to reach, but nurse leaders must ensure that clinical systems reflect the diverse range of beliefs that people hold

Some communities may be hard to reach, but nurse leaders must ensure that clinical systems reflect the diverse range of beliefs that people hold

Illustration in rainbow colours of a crowd of people in silhouette. Paul Edwards, director of clinical services for Dementia UK, says healthcare systems such as the dementia diagnostic pathway must be flexible in adapting to people’s deeply held beliefs
Picture: iStock

A few years ago, while working in Japan, I had a conversation with a nurse who described how worried she was about an older couple who lived near her. It appeared that both were becoming increasingly frail and the wife had been developing cognitive problems for some time.

The nurse had tried repeatedly to encourage the couple to receive medical and social support, but they refused.

In Japan, as in many advanced countries, there are well developed processes, protocols and pathways to help in situations like this. The question for the nurse and me was why there was reluctance to accept help.

‘Nurses need to take the time to understand cultural belief systems’

We talked it through and she described to me the strength of belief within Japanese culture in stoicism, duty, intellect and cognitive function. For this couple, it wasn’t access to services that was the issue, it was their belief system that appeared to hold them back.

How strongly cultural beliefs are held may well affect how people act, react and respond, and this may well come on top of fear and anxiety associated with health problems. We as nurses need to understand that beliefs can becompelling.

I still hear nurses talking about how challenging it can be for some communities to access services. While there is truth in this, nurses need to take the time to understand cultural belief systems and then try to adapt, reflecting these belief systems in our pathways and protocols.

The key here is how flexible our healthcare systems are to being adapted to deeply held beliefs. If we consider a typical diagnostic pathway for dementia, for example, how rigid does it need to be? And with a little adaptation, could it be more palatable and acceptable to the diverse range of cultures in the UK?

This is not just about language and translation of materials to describe a particular pathway, vitally important though they are. There has to be an ability to understand overarching belief systems across diverse cultures if we are truly to open up healthcare pathways.

Translating materials is essential but to widen access to services we as nurses should recognise the importance that cultural belief systems play in a person’s confidence about seeking access to services.

‘Nursing is uniquely placed to participate in designing new approaches’

If we want services to reach wider communities, incorporating cultural belief systems at the design stage may well help us to create much more accessible routes to care and treatment.

Nursing, with its own diverse workforce, is uniquely placed to participate actively in designing new approaches to accessing health and social care services. At the moment, however, it seems to be an untapped resource.

    How do we as nurse leaders harness our diverse nursing and care workforce to inform routes to care and influence the development of new systems, pathways and processes?

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      There are many examples of diagnostic and treatment pathways being adapted to meet the needs of specific cultural beliefs and systems, but a question remains as to whether the pathway comes first and is then adapted, as opposed to us developing a truly culturally adaptable pathway from the outset.

      We should challenge our clinical systems and our colleagues to make sure they reflect the diverse range of beliefs that people hold.

      We need to move away from just accepting that some communities are hard to reach, and delve much deeper into creating services that embrace diversity and are adaptable to varying cultural beliefs. Only then can we hope to reach all those who need support and care from the nursing community.


      Paul Edwards is director of clinical services at Dementia UK and a member of the Nursing Management editorial advisory board

       

       

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