Chapter 2
Thoughtful practice
27
Time
Attitudes about time vary widely between people of different
cultures, and this can be a barrier to effective communication.
Views about punctuality and the use of time are culturally
determined, as is the concept of waiting. For example, for
most Western, as opposed to traditional, healthcare providers,
time and promptness are extremely important; for example,
nurses usually expect patients to arrive at a specific time for
an appointment. In some cultures, however, time is a relative
phenomenon, not one that is assessed or counted in hours or
minutes. For example, in traditional Aboriginal and Torres
Strait Islander and Ma¯ori cultures the conception of time
is marked by an emphasis on cyclical continuity, not lineal
change: the past and the future may be seen as integral parts of
the present. Consequently, events of the time, such as a partic-
ular family business, illness, and funerals, may take precedence
over any previously made healthcare appointment.
The value placed on particular events, and hence their
priority within a framework of time, should be explored by
the nurse. Being flexible in regard to schedules is a positive
way of accommodating cultural differences in this regard.
For example, scolding or expressing annoyance at a patient
for being late may be seen as an expression of a nurse’s
ethnocentrism.
This could undermine the patient’s confidence in the
healthcare system, and result in further missed appointments
or the rejection of the system.
Touch
The meaning people give to touch is a cultural construction.
In some cultures (e.g. traditional Arab, Aboriginal and Torres
Strait Islander and Ma¯ori cultures), male healthcare providers
may be prohibited from touching or examining certain parts
of the female body. The concept of shame may also be impli-
cated in a preference for gender-specific healthcare providers.
Similarly, it may be inappropriate for females to care for males.
Among some Ma¯ori, care of certain areas of the body is con-
sidered
tapu
(sacred), while among traditionally orientated
Australian and Torres Strait Islanders the propriety of such
close interaction is based on kinship relations. Among many
Asian peoples, it is considered impolite to touch a person’s
head because their spirit is believed to reside there. Therefore,
assessment of the head or evaluation of a head injury may
require alternative approaches. For other patients, a sense of
modesty may be implicated in the use of touch, and so this
must be considered when providing nursing care.
Observance of holidays
People from all cultures celebrate civil and religious holidays.
Nurses should familiarise themselves with the major holidays
for members of the cultural groups with whom they work.
Routine health appointments, diagnostic tests, surgery, and
other procedures should be scheduled to avoid those holidays
a patient identifies as significant. Efforts should also be made
to accommodate patients, their family, or significant others,
when not contraindicated, as they perform holiday rituals in
the healthcare setting.
Diet and the meaning of food
The cultural meaning of food and those practices associated
with it vary widely. Usually the meaning of food is related to
one or more of the following: relief of hunger; promotion of
health and healing; prevention of disease or illness; expression
of caring for another; promotion of interpersonal closeness
among individuals, families, groups, communities, or nations;
and promotion of kinship and family alliances. Food may also
be associated with solidification of social ties; celebration of
life events (e.g. birthdays, marriages, funerals); expression
of gratitude or appreciation; recognition of achievement or
accomplishment; validation of social, cultural, or religious
ceremonial functions; facilitation of business negotiations; and
expression of affluence or social status.
Cultural dictates or preferences determine which foods are
served and when they are served, the number and frequency
of meals, who eats with whom, and who is given the choicest
portions (Chart 2-5). Beliefs and values also determine how
foods are prepared and served; how they are eaten (with chop-
sticks, hands, or cutlery); and where people obtain or purchase
Prohibited foods and beverages of selected religious groups
Hinduism
All meats
Animal shortenings
Islam
Pork
Alcoholic products and beverages (including extracts such as
vanilla and lemon)
Animal shortenings
Gelatin made with pork, marshmallow and other confectionary
made with gelatin
Note: Halal food is lawful food that may be consumed
according to tenets of the Koran, whereas Haram is food
that is unlawful to consume.
Judaism
Pork
Predatory fowl
Shellfish and scavenger fish (e.g., shrimp, crab, lobster,
escargot, catfish). Fish with fins and scales are permissible.
Mixing milk and meat dishes at same meal
Blood by ingestion (eg, blood sausage, raw meat).
Note: Packaged foods will contain labels identifying kosher
(‘properly preserved’ or ‘fitting’) and pareve (made without
meat or milk) items.
Mormonism (Church of Jesus Christ
of Latter-Day Saints)
Alcohol
Beverages containing caffeine stimulants (coffee, tea, colas, and
selected carbonated soft drinks).
Seventh-Day Adventism
Alcohol
Beverages containing caffeine stimulants (coffee, tea, colas, and
selected carbonated soft drinks)
Pork
Certain seafood, including shellfish
Fermented beverages
Note: Optional vegetarianism is encouraged.
CHART
2-5
