Chapter 3 | Family Dynamics and Communicating With Children and Families 39
DEFINITION OF A FAMILY
SAFE AND EFFECTIVE NURSING CARE: Cultural Competence
A family consists of two or more members who interact and depend on one another socially, financially, and emotionally. Until the early 1960s, nuclear families consisting of a husband, wife, and children were the norm in the United States (Fig. 3–3). The exception was during the Great Depression, when multi- ple generations living in one household became more common because of economic necessity (Fig. 3–4). Nuclear families were portrayed by the media in television by The Adventures of Ozzie and Harriet and Leave It to Beaver. Single widowed parents were also shown with television shows such as The Andy Griffith Show. The 1960s saw tremendous turmoil caused by political, social, and cultural changes resulting from the Vietnam War and the emergence of civil rights for women and minorities.
Communication To facilitate communication with children and families from cultures other than their own, the nurse should: ● Include family members in interactions. ● Be an active listener. ● Be present when families and children need to talk. ● Observe verbal and nonverbal cues. ● Understand that family responses to wellness and illness strongly influence behaviors. ● Learn culturally appropriate interactions, such as whether to use eye contact and whether shaking hands is welcomed in the client’s culture. Be mindful of pauses and personal space. ● Repeat important information more than once and speak slowly. ● Avoid medical jargon, instead using terms family members can understand. ● Allow time for questions. ● Give information in the family’s native language. Use certified interpreters as necessary. ● Address intergenerational needs.
SAFE AND EFFECTIVE NURSING CARE: Cultural Competence
FIGURE 33 A nuclear family (mother, father, child, or children).
Legal Requirements for Interpretation The 1964 Civil Rights Act states that no person should be de- nied the benefits of or experience discrimination in any pro- gram receiving federal assistance based on race, color, gender, or natural origin. The Supreme Court determined that discrimi- nation based on language amounts to discrimination based on natural origin. This legally requires health-care institutions to provide language accessibility for patients. Many states, such as California, New Jersey, and Washington, have enacted health-care interpreter certification as directed by the National Council on Interpreting in Healthcare, which advocates for the development and implementation of national standards of practice for interpreters in health care (Chen, Youdelman, & Brooks, 2007; Friedman, 2014; National Conference of State Legislators, 2016). Facilities not covered by federal funds may still be subject to individual state laws (National Conference of State Legislators, 2016). The lack of trained medical inter- preters in a health-care setting puts children and families at risk and is a form of discrimination.
FIGURE 34 An extended family may have three generations of a family living together.
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