Bridging obstacles to transcultural caring relationships—Tools discovered through interviews with staff in pediatric oncology care

Summary

In this qualitative study we explored how health-care staff continuously resolve “obstacles to transcultural caring relationships” as they care for families with an immigrant background within the context of pediatric oncology care. A constant comparative method was used and data collection included 5 focus group interviews and 5 complementary individual interviews with health-care staff within pediatric oncology care. Bridging emerged as the way that health-care staff deal with obstacles to transcultural caring relationships. Bridging is a process in which various tools may be used and combined, including communicational tools, transcultural tools and organizational tools. Failure to use tools, or to use and combine them insufficiently, can bring the caring relationship to a halt, which leads to inequity in care. In order to ensure the provision of high-quality care despite differences in religion, culture, language and social situation, health-care staff need to bridge obstacles to transcultural caring relationships.

Zusammenfassung

In dieser qualitativen Studie untersuchten wir, wie Mitarbeiter im Gesundheitswesen, die krebskranke Kinder aus Familien mit Migrationshintergrund betreuen, nachhaltig „Hindernisse für transkulturelle fürsorgliche Beziehungen“ beseitigen können. Es kam eine konstante vergleiche Methode zur Anwendung. Die Datengewinnung erfolgte in fünf Fokusgruppeninterviews und fünf ergänzenden individuellen Interviews mit Mitarbeitern aus kinderonkologischen Einrichtungen. Es zeigte sich, dass die diese Mitarbeiter mittels „Bridging“ auf Hindernisse für interkulturelle fürsorgliche Beziehungen reagierten. „Bridging“ ist ein Prozess, bei dem diverse Instrumente angewendet und kombiniert werden können, unter anderem kommunikatorische, transkulturelle und organisatorische Instrumente. Werden die Instrumente nicht angewendet oder nicht in ausreichendem Maße kombiniert, kann sich dies negativ auf die fürsorgliche Beziehung und damit auch auf die Qualität der Pflege auswirken. Um trotz unterschiedlicher Religionen, Sprachen und sozialer Situationen eine Pflege von hoher Qualität gewährleisten zu können, müssen Mitarbeiter aus kinderonkologischen Einrichtungen Hindernisse für transkulturelle fürsorgliche Beziehungen überbrücken.

Introduction

Sweden's population of a little more than nine million includes 16.7% with an immigrant background, including people born in a foreign country or with both parents born in a foreign country (Statistics Sweden, 2007). During 2006, 48% of immigrants came from European countries, 35% came from Asia, including immigrants from Iraq as the largest group, and 10% came from Africa (The Swedish Migration Board, 2007). With over 100 nationalities represented in Sweden, cultural diversity is evident in health care (Baarnhielm et al., 2005), including pediatric oncological care.

In Sweden in 2005, 348 children between 0 and 19 years old were diagnosed with cancer (The national board of health and welfare (Socialstyrelsen), 2007). Most patients with pediatric cancer respond well to treatment (Gatta et al., 2003), but this is usually a long-term condition that entails intensive and demanding medical treatment lasting between six months and two and a half years (Gustafsson et al., 1998), depending on the type of cancer. Childhood cancer is very stressful for the entire family (Bjork et al., 2005; Marky, 1982; Woodgate and Degner, 2003). The family's experience has been described as “getting through all the rough spots” (Woodgate and Degner, 2003) and “a broken life world” (Bjork et al., 2005). In Sweden, at least one family member or relative is usually active in the care of the child and stays at the hospital. In a study by von Essen et al. (2001), parents of children with cancer considered that the most important aspects of care were social competence, information, adequate care of their child, emotional support and time. Given the duration of treatment, long-term caring relationships are involved that are important to develop and optimize. The caring relationship is described by Eriksson (2000) as the foundation of the “caring process”. Transcultural caring relationships are professional relationships across cultures that aim to support the health process of patients and provide culturally congruent care; they include health-care staff relationships with patients and/or families (Pergert et al., in press). In that study, “obstacles to transcultural caring relationships” emerged as the main concern of health-care staff. These obstacles are conditions that can hamper mutual understanding and damage or even block the relationship's further development. They include linguistic, cultural and religious, social, and organizational obstacles. Moreover, a number of studies have shown that communicational obstacles interfere with the development of caring relationships (Covington, 2001; Donnelly, 2000; Lavizzo-Mourey and MacKenzie, 1995; Richardson and Thomas, 2006; Trill and Holland, 1993). When health-care staff fail to recognize obstacles to transcultural caring relationships, the consequence is inequity in care.

The importance of equity in health has been highlighted by the World Health Organization (1991), which has proposed that discrepancies in health status between groups in and between countries need to be reduced by raising the level of health of disadvantaged groups. The national public health commission (2000) in Sweden has developed a national health policy with a strong focus on reducing health inequalities; Sweden also has regional and national policies for equal access to care regardless of background (Blomgren and Stockholm County Council, 2002). Despite the policies and requirements in Sweden, several national studies on care (Albin et al., 2006; Essen et al., 2000; Gadd et al., 2003; Robertson et al., 2003, Robertson et al., 2005) and a national review (Lindencrona et al., 2006) have indicated inequalities in health and health care between patients with an immigrant background and the majority population. This inequality also exists in research because families with an immigrant background are a heterogeneous group and that tends to result in their exclusion from research.

In general, as well as in pediatric oncology, health-care staff “must be prepared adequately to meet the needs of the whole population” (Chevannes, 2002, p. 291) and have an obligation to provide culturally congruent and competent care (Covington, 2001; Lavizzo-Mourey and MacKenzie, 1995; Leininger and McFarland, 2002; Price and Cortis, 2000; Richardson, 1999). While research on and around culturally competent and congruent care may have made great progress in other areas of care, in pediatric oncology there are still discoveries waiting to be made (Hicks and Lavender, 2001; Munet-Vilaro, 2004). There is also a need for studies in pediatric oncology to facilitate communication across language barriers (Abbe et al., 2006; Sobo, 2004).