http:// ijp.mums.ac.ir Original Article (Pages: 4329-4341)

The Exploration of Culturally Sensitive Care in Pediatric Setting: a Qualitative Study Leila Valizadeh1, Vahid Zamanzadeh2, Akram Ghahramanian3, *Parvaneh Aghajari41

1Associate Professor, Department of , Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, . 2Professor, Department of Medical , Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. 3Assistant Professor Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. 4Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: One of the essential aspects of the provision of care is cultural issues. Cultural sensitivity is the key for cultural care. The aim of this study was to explore culturally sensitive care in pediatric nursing care in Iran. Materials and Methods: This study was a conventional content analysis. Participants were consisted of 25 nurses and 9 parents selected through purposive sampling from three pediatric referral centers in Tabriz and Tehran, Iran. Data was collected using semi-structured interviews and field notes and were concurrently analyzed by using Graneheim and Lundman (2004) method. Data was transcribed verbatim, words, sentences, and phrases were considered meaning units, abstracted, labeled and compared for developing categories. Results: Culturally sensitive care of a sick child was consisted of three themes: ‘cultural exposure’, ‘intercultural communication’ and ‘the reconciliation of cultural conflict in families/care’. During the ‘cultural exposure’ nurses were informed of the cultural manifestations, strived to identify and understand /families with cultural diversities and respect their cultural beliefs. The nurse used the native language in ‘intercultural communication’ or a combination of verbal and nonverbal communication methods to reach a common understanding. Finally, a nurse in the conflict between the culture of child/family and care took actions for making decisions to develop a compliance between care and the family culture and amended parents’ harmful desires through negotiation and appropriate care. Conclusion: Understanding the concept of culturally sensitive care, can help with resolving the problems of cultural exchanges in Pediatric wards. Providing cultural facilities and interpreters to communicate with patients/family increase their satisfaction. Key Words: Child, Cultural diversity, Culturally sensitive care, Nurses, Qualitative research.

*Please cite this article as: Valizadeh L, Zamanzadeh V, Ghahramanian A, Aghajari P. The Exploration of Culturally Sensitive Nursing Care in Pediatric Setting: a Qualitative Study. Int J Pediatr 2017; 5(2): 4329-41. DOI: 10.22038/ijp.2016.7975

Corresponding Author: Faculty of Nursing and Midwifery, Shariati Street, Tabriz. Postal codes: 5138947977. Email: [email protected] Received date: Nov.23, 2016; Accepted date: Dec. 22, 2016

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1-INTRODUCTION workers need to strengthen cultural Cultural diversity is defined as awareness, cultural sensitivity and variations and differences between and responsibility for providing healthcare within groups in life, language, values, services (9). Tucker et al., introduced norms and other cultural aspects (1). Iran -centered care included culturally is a country with diverse religions and sensitiveness. They emphasized behaviors different ethnic groups, each with its own and attitudes specific to the patient (such customs, language and identity. The as making the patient to feel comfortable, presence of different religions and respecting the patient and attracting his/her ethnicities highlights the importance of trust to the caregiver); also highlighted the culture (2). need for the collaborative patient-centered Cultural sensitivity is the most relationship between the patient and comprehensive concept for being aware of healthcare provider with a focus on empowering the patient as the main feature knowledge related to ethnicities and religions, which is used for describing and of culturally sensitive care (10). understanding individual’s characteristics Cultural sensitive care of a sick child and his/her responses (3). It is also defined should be able to respond to the attitudes, as the individual’s interest for feelings and conditions of those with understanding others’ sub-cultures (4). In specific attributes of identity. Such care the process of care and treatment of coincides with the patient/family values patients, the ignorance of cultural diversity and beliefs and makes them feel leads to inequality, discrimination, comfortable, respected and trusted to misunderstanding and stereotypes (1). On healthcare providers (7). Culturally the other hand, care proportional to the sensitive care is sensitive to the needs of culture reduces inequality and its each patient based on his/her eating habits, consequences, prevents discrimination, religious and linguistic needs of the misunderstanding, ignorance and patient/family and is designed for each stereotypes and provides conditions for patient (3). Knowledge, attention, respect, equal patient care. For this reason, the understanding and the appropriate care provision of culturally sensitive care to plan are the characteristics of culturally patients with a diversity of culture and sensitive care (8). ethnicity is of special importance (5). The results of a study by Heidari in Iran, In the provision of culturally sensitive show that culturally sensitive care is care, a healthcare provider needs to inadequate in adult wards, because nurses understand cultural differences and have not received proper education and are consider the needs and expectations of able to provide care only based on their patients, gain their trust and plan for own cultural intelligence and initiative appropriate patient care. Those patients thinking (11). Since family-centered care who trust their health caregivers are honest is essential for providing care to children and provide them with more information (12), the family’s involvement in childcare about their culture (6, 7). Culturally is important for nurses (13). Differences in sensitive care also leads to effective parents’ perceptions of treatment and care, communication, effective intervention, and variations in the parents and nurses’ patient satisfaction (8), a change in the expectations are due to the influence of lifestyle and adherence to the diet and culture (14). Each parent has a unique treatment regime. This requires an parenting style (15) and engage in understanding of patients' views on the healthcare based on various factors such as meaning of their illness. Healthcare culture, ethnicity, language, gender and

Int J Pediatr, Vol.5, N.2, Serial No.38, Feb. 2017 4330 Valizadeh et al. socio-economic factors (14). The available North-East and Capital of Iran (Tabriz and evidence suggests that despite education Tehran cities). and planning for the provision of culturally 2-1. Study Design and Population sensitive care, healthcare settings are far away from this concept and there is a need This study completed through a to research on this topic (16). Although conventional content analysis method. culturally sensitive care is widely Participants were consisted of 25 nurses accepted, the nature of this concept has not and 8 mothers and one father selected been clearly defined (17, 18). Also, no through purposive sampling from Pediatric study has been performed with regard to wards of hospitals in three pediatric culturally sensitive care in pediatric referral centers (two referral centers in nursing in Iran. The available studies Tabriz and one referral center in Tehran). mainly have focused on communication The study population included the nurses with parents and young nurses, nursing of and parents in pediatric wards who worked premature infants and their parents. or had hospitalized child experience in pediatrics ward. In addition, Iran is a multi-ethnic society (2). On the other hand, according to recent 2-2. Methods developments in Iran, Iranian nurses are Participants were selected from Pediatric providing care to different ethnic groups wards of hospitals. Researcher referred to within the country and provide healthcare these centers, found nurses and parents services to the Persian Gulf states and from different races and, explained the aim Azerbaijan, etc. The health tourism of the study for them, checked inclusion industry in Asia and especially Iran, has criteria and asked about their willingness expanded and 20-25 thousand tourists to participate in study. Sampling was first annually refer to Iran for receiving performed as purposeful among the treatment (19). Therefore, understanding volunteers and then was continued with and respecting religious rituals and beliefs maximum diversity sampling (in terms of of the family have deepened the human gender, age, education, race, and work aspects of the relationship between nurse experience). and family, which is the pillars of care in children. The clarification of the concept 2-3. Measuring tools of cultural sensitivity in the care for sick Data were collected using semi-structured children and learning related behaviors in interviews and field notes were taken the nursing community through its during the nurse-parent’s interactions in inclusion in the curriculum and in-service Pediatric wards and helped with data nurses’ education can improve the nurse- collection from ethnics’ parents from parent/child’s relationship and satisfaction. Balochestan, Guilan and Arabs, which the Due to a lack of knowledge on culturally researcher was unable to communicate sensitive care and importance of with them verbally due to different qualitative research in identifying and languages. exploring the experiences of participants, this study aimed to explore culturally The duration of the interviews were from sensitive nursing care in pediatric setting. 30 to 85 minutes. The interviews were held in quite places convenient to participants 2- MATERIALS AND ETHODS such as the nurses’ rest room or the patients’ rooms. The interviews were This study was conducted from July started with a general question and 2015 to March 2016. The study was continued with specific questions with conducted in pediatric referral centers in regard to the study phenomenon. The

Int J Pediatr, Vol.5, N.2, Serial No.38, Feb. 2017 4331 Culturally Sensitive Care in Pediatric Nursing questions used during the interviews were to their similarities and differences for as follow: developing categories. The process of coding and categorizing was discussed by  What is the meaning of culturally the researchers to resolve disagreements. sensitive care? The data collection was continued until

 What are the characteristics of data saturation was reached (20). For culturally sensitive care? example three conceptual codes including Also, probing questions such as ‘would "Consideration of the child/family you explain it more? ’, ‘what does it culture", "Understanding the child/family mean?’ and ‘why?’ were asked to improve culture" and "Valuing culture" has been the depth of the data collection. emerged from this meaning unit "Nurses 2-4. Inclusion criteria often considered, understood and respected Inclusion criteria for nurses were having the patient/family’s language, dress and an associate degree and the work nationality to understand his/her needs and experience of working in pediatric wards met them"; and then these conceptual for more than two years. The inclusion codes formed the sub-category criteria for parents was the history of "Considering and valuing the culture of the child’s hospitalization for one week in child/family". pediatric wards. In the next step, the category "Cultural exposure", were formed from two sub- 2-5. Exclusion criteria categories "An awareness of the cultural Exclusion criteria were: lack of manifestations of the child/family’s participant’s willingness to continue cultural encounter" and "Considering and cooperation in every stage of the study. valuing the culture of the child/family". 2-6. Ethical considerations Prolonged engagement with the The Tabriz University of Medical participants, immersion in the data, peer Sciences, Tabriz, Iran ethics committee checking, member checking, and external proved this study’s ethical considerations checking helped with the rigor of this (ID code: TBZMED.REC.1394.168). The study. A brief report of the interviews, aim and process of this study were codes and categories were sent to three described to the participants and nurse researchers for checking the analysis permission to tape-record the interviews process. Also, some nurses working in the was obtained. They had the right to pediatric ward were asked to check withdraw from this study at any. Those findings to ensure that their perspectives who willingly agreed to participate in this were accurately reflected and finding are study were asked to sign the written meaningful for them and as the same as informed consent form. their experience. Maximum variations in sampling, audit trail and the description of 2-7. Data analyses the data collection and analysis processes The method suggested by Graneheim and were considered to improve the Lundman (2004) was used for data transferability of findings. The aim and analysis (20). The interviews were process of this study were described to the transcribed verbatim and along with field participants and permission to tape-record notes were read several times to get the the interviews was obtained. They had the sense of whole. Words, sentences, and right to withdraw from this study at any. phrases were considered meaning units, Those who willingly agreed to participate abstracted and labeled with codes. The in this study were asked to sign the written codes were compared together with regard informed consent form.

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3- RESULTS "During education, we are not taught about The demographic characteristics of the culturally sensitive care and there is no participants were presented in Table.1. such a thing in textbooks. Also, nothing The culturally sensitive care of a sick child has been done in the hospital with regard was consisted of three themes: ‘cultural to cultural care as no education is given to exposure’, ‘intercultural communication’ staffs who work with nationals and and ‘the reconciliation of cultural conflict ethnicity groups" (Nurse 4). in families/care’ (Table.2). The nurses stated that they had become familiar with other cultures’ customs 3-1. Cultural exposure during the provision of care to patients The nurses stated that they encountered with various cultures and religions. They with patients with different ethnicities and were familiar with religious beliefs, some nationalities. This theme was physical allegories, traditional remedies consisted of the following subcategories: and superstitions prevalent among ‘an awareness of the cultural different ethnic groups due to their work manifestations of the child/family’s experiences as nurses. cultural encounter’ and ‘considering and valuing the culture of the child/family’. "I have seen here remedies such as rubbing blood on the baby's body, rubbing 3-1-1. An awareness of the cultural Zamzam water and feeding the newborn manifestations of the child/family’s with religious water" (Nurse 10). The education of cultural care and culturally sensitive care are neglected in nursing and in-service education.

Table-1: Demographic variables of nurses and parents who participated in research Variables Nurse (number) Parents (number) Female 23 8 Gender Male 2 1 25-35 9 8 Age (year) 35-45 15 1 > 45 1 - Elementary - 2 High school - 1 Education Diploma - 3 Bachelor 19 1 Master degree 6 2 Fars 5 2 Azerbaijani(Iranian) 11 3 Kurdish 2 2 Luri 1 - Mazani 2 - Race Gilak 1 - Taleshi 1 - Arab 1 - Baloch 1 - Azeri(Azerbaijan) - 2 2-10 year 9 - Work experience (year) 11-21 year 13 - Higher than 20 year 3 -

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Table-2: Categories and subcategories developed in this study Category Subcategory Codes Cultural knowledge Religious beliefs Traditional treatments An awareness of the cultural Cultural customs manifestations of the child/family’s Physical allegory cultural encounter Cultural exposure Superstitions

Considering and valuing the culture Consideration of the child/family culture of the child/family Understanding the child/family culture Valuing culture Personalizing care Appropriate communication with the child/family The native language/body language Incomplete verbal communication Intercultural Nonverbal communication communication Reaching common understandings Efforts to improve communication skills

Understanding concepts Inappeasable parents Implementation of traumatic family culture

The domination of culture on care Hospital culture imposition The reconciliation Dealing with customs and unreasonable demands of cultural conflict The domination of care on culture Convincing parents in families/care

Adaptation Preferences expressed by parents Nurse's impartiality against the beliefs of parents Adjusting harmful needs

3-1-2. Considering and valuing the culture of the child/family Nurses often evaluated the patient’s The nurses declared that they paid more language, dress and nationality to attention to the child/parent who had a understand his/her needs and met them. In different culture to relieve their sense of most cases, the nurses did not oppose their alienation and loneliness. cultural beliefs and did not impose their own culture to the patient. "When my patient is from another culture and is stranger here between us, I take care "When I pay attention to the child and of him/her and communicate with him/her parent’s culture, I find what they need and to prevent the feeling of loneliness and may ask….I do not oppose their provide appropriate care to him/her" perspectives and do not impose mine" (Nurse 4). (Nurse 12). Given the importance of nurses own Also, the nurses were sensitive to the cultural meanings of the behavior and beliefs, they respected parents’ values and appearance in care, and considered the accepted them. child/parent cultural beliefs and reasonable "As I believe in something and consider demands, which did not led to legal them values, parents value something that consequences. "I consider the appearance, should be respected….I do not have any dress mode and talking of parents for problem with what they do as Muslims" understanding their culture" (Nurse 8). (Nurse 14).

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The night shift nurse reported the child’s "I communicate to parents depending on health condition to the head nurse during their level of education and culture. I the work shift change and stated: "During communicate with them and explain medication, I found that the father of this complex words. If I use complex words, child has three wives". The head nurse they do not understand what I'm saying" immediately said: ‘This is true that (Nurse 2). polygamy is common among Balochi If the nurses were unfamiliar with the culture, but this is rather nice to not judge child/parent’s language, imperfect verbal others at all’ (Field note 5). communication using learned words and When visitors from neighboring countries with the help of other people such as or different ethnic groups have the same colleagues, other patient family or religious values with caregivers, parents interpreters, writing and gesture would be are encouraged to implement calming established. customs in critical conditions as one of the "I use those words I know. In many cases, conventional methods of family care. I have access to an interpreter or I use "When the child experience seizure, I ask nonverbal communication or gestures" the mother to put her trust in God. I (Nurse 22). encourage the mother to pray to God and "There are parents in our ward with read religious verses to make her calm" various languages such as Kurdish, Lurish (Nurse 5). and Turkish, that are unable to talk in The nurses evaluated patients’ values and Farsi. I have some colleagues in the ward beliefs and provided equal care to patients who are able to communicate with their with the consideration of individual’s languages. I received help from my culture and context. colleagues to communicate with such "Those patients who have different parents" (Nurse 18). cultures should be treated differently, "In the surgery ward, I observed the because they may have different cultural communication between the nurse and needs and disease-based education" (Nurse Arab parents. The nurse was doing post- 3). surgery care and checked the surgery’s site 3-2. Intercultural communication on the child’s neck. She asked the parents From the participants’ perspectives, to inform the nurse if any bleeding intercultural communication is the core of happened with some words of Arabic nursing for caring patients with cultural language. She should used gestures to diversities. This includes two educate the parents who to elevate side subcategories of ‘the native language/body rails" (Field note 3). language’ and ‘reaching common Also, the nurses tried to make themselves understandings’. familiar with the language and cultures of patients for improving their 3-2-1. The native language/body communication skills. language Nurses try to get familiar with those "…I requested a mother to teach me the patients who were familiar with the Kurdish language" (Nurse 6). national language and culture and provide "…I ask parents about their cultures and appropriate care to the child/family. Such a try to learn about them" (Nurse 23). communication was made based on the parent’s level of understanding without the 3-2-2.Reaching common understandings use of jargons.

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The nurses clarified and explained because I did not want to bother her" concepts to make effective communication (Nurse 17). with parents for reaching a common "If parents insist, I do what they say. For understanding with them. Therefore, to instance, the parent asked me to find a vain reach a common understanding, they used from another hand of the child, because strategies such as repeating, explaining one hand of the child was covered by a with domination, and giving feedbacks. piece of fabric based on their rituals" A parent said: "If I do not understand what (Nurse 19). the nurse says, I ask her to repeat and explain it more. The nurse taught with her In spite of the education provided by the behaviors how to check the child’s fever" nurses, parents practiced based on their (A mother from Azerbaijan). superstitions and even forced the nurses to practice based on their own will. 3-3. The reconciliation of cultural conflict in families/care "…She [the mother] gave the child butter and Sisymbrium irio seeds without The nurses achieved effective outcomes informing me. She was taught by her through a dialogue for intertwining relatives to do so and she did" (Nurse 7). childcare with the child/ family care. This was consisted of the following 3-3-2.The domination of care on culture subcategories: ‘the domination of culture Sometimes, the nurses imposed the culture on care’, ‘the domination of care on of the hospital to parents and asked them culture’ and ‘adaptation’. to follow routines. The nurses did not 3-3-1. The domination of culture on care respond to irrational and unscientific customs of families, especially those The nurses believed that families were overwhelming and traumatic ones. In such allowed to implement their safe beliefs and cases, the nurses ignored the parents’ values in the hospital. However, if parents cultural rituals and tried to calmly and hindered the provision of care by their smoothly convince them to accept routine superstitious beliefs, the nurses explained care and leave their harmful cultural rituals the care process and tried to convince them without any protest to nursing care. of the necessity of care. If parents would not be convinced, their dissatisfaction of "I say parents not to use herbal medicine care would be documented in the patient during hospitalization. Perhaps, herbal care. medicine cause unpredicted consequences "Sometimes parents do not allow us to and neutralize medical regime" (Nurse 22). provide the required care to the child. They "When parents perform treatments that do not give the consent to perform may endanger the child’s health, I get invasive nursing procedures. Lastly, we angry and send feedbacks to them" (Nurse document it in the patient file" (Nurse 5). 21). Sometimes, nurses were forced by parents 3-3-3. Adaptation to carry out what they wished, which were mainly harmful. The nurses provided ample opportunities for parents to express their desires and "Based on her rituals, a mother did not beliefs and provided culturally appropriate allow me cut the child’s hair for vein care with the consideration of their culture catheterization from the head. I insisted, and context. If, parents’ desires did not but the mother opposed my will. endanger the child health, they were Therefore, I surrounded to her will, allowed to follow them. Also, the nurses

Int J Pediatr, Vol.5, N.2, Serial No.38, Feb. 2017 4336 Valizadeh et al. negotiated with parents to adjust their The results of this study showed that in desires for childcare. pediatric wards, nurses considered and "If parents do not allow me to perform the compared their own culture with parents’ nursing intervention such as inserting the customs, beliefs and cultural values. They urinary catheter, I negotiate with them" tried to understand parents’ cultural needs (Nurse 23). and respect them. The nurses accepted parents’ faith and beliefs and use them in "I adapt with the condition and allow critical conditions to calm parents. The parents to declare their perspectives and nurses also regardless of ethnicity or wishes, follow their rituals, if they are not culture provided equal care to patients and harmful to the child and do not hinder us tried to provide appropriate care based on for patient care. I incorporate their wishes their culture. Heidari similarly stated that and perspectives into childcare" (Nurse nurses respected patients’ values and 19). provided facilities to perform their religious affairs for providing cultural care 4- DISCUSSION to adults. He added that nurses without The aim of this study was to explore asking any questions about patient's culturally sensitive care in pediatric religions behaved equally with different nursing care. The finding of this study ethnic groups (11). showed that cultural exposure was one of The results of the study by Tavallali et al., the main aspects of culturally sensitive indicated that parents in multicultural care and the nurses were involved with the societies expected nurses in pediatric provision of care to patients with various wards to be aware of different cultures and cultures. Similarly, Jirwe et al. in a study customs and adapt themselves to them. In on nursing students in Sweden believed their views, this raised nurses’ abilities to that they were involved in cultural respect their cultural diversities and exposure, because they provided care to interest to provide care to patients with foreign patients and their families (21). different cultures (25). Cultural awareness Foronda also introduced cultural exposure is the background of culturally sensitive as the background of culturally sensitive care and understanding and respecting the care (8). The results of this study showed culture of the patient are the features of that cultural exposure needed to be aware culturally sensitive care. For providing of the manifestations of different cultural culturally sensitive care, the nurse should and ethnic groups. Although in most be able to be aware of his/her own culture countries with cultural diversities, cultural to recognize its differences with other knowledge is taught during academic people’s cultures (8). programs, but the education of cultural sensitivity in Iran like Turkey, Italy and Noting, understanding and respecting the Korea has no place in the nursing culture of the patient is the building block curriculum that increases the possibility of for developing trust between the nurse and dealing with problems (22-24). patient and facilitating patient satisfaction and adherence to treatment (26). Providing However, the results of this study showed information for understanding beliefs, that pediatric nurses had appropriate expectations, preferences and behaviors of knowledge about cultural issues. Heidari’s different religions, considering and study on cultural care showed that despite respecting the patient/family’s needs are educational exclusion of nurses in Iran, the best methods for patient care (27). nurses provided cultural care by using their Chen and Rankin showed that religion is emotional intelligence (11). the emotional aspect of people's lives and

Int J Pediatr, Vol.5, N.2, Serial No.38, Feb. 2017 4337 Culturally Sensitive Care in Pediatric Nursing providing facilities for religious practices their parents is one of the most challenging is the most important tasks associated with tasks in pediatric nursing (36). The cultural sensitive care in elderly care in language plays an important role in South Asia (28). Inhorn et al., noted that cultural differences, because language Muslim caregivers should be sensitive to differences between the nurse and patient religious issues, because these issues have hinders communication (37). In addition, a direct impact on their care (29). differences of language, culture, gender According to the findings of this study, the and accent are barriers to nurse-patient nurses used two methods for making communication and provision patient care intercultural communication with the (11, 38, 39). This study was performed in child/parent. If they were familiar with the pediatric wards with young children and native language of the child/family, an the majority of nurses were female. Most appropriate cultural relationship was of the time, mothers were staying with their hospitalized child in wards. established. If not, they used verbal and nonverbal clues and asked from an Therefore, gender differences between interpreter for reaching a mutual parents and nurses were undermined. understanding. These are supported by The findings of this study showed that the Heidari and Taylor et al. findings (8, 30). nurses experienced cultural conflicts in Heidari stated that nurses overcome the pediatric culturally sensitive care. Then language barriers using translators, they made decisions to develop a bilingual co-workers, family members, compliance between care and the family’s gesturing and their own previous culture. Nurses in the cultural conflicts of knowledge of the language (11). The the family/care persuaded parents to cornerstone of the quality of care in correct their misunderstandings, made pediatric nursing is the relationship decisive actions, and focused solely on between parents and caregivers (31). Its their care and treatment methods. Heidari’s main elements are understanding and study also showed that nurses provided communicating, being influenced by the culturally sensitive care to patients attitudes of professionals and families’ rectified their poor habits through showing desire to participate in patient care (32). respectful behaviors to their values and provided necessary education to adjust Nurses must be able to communicate with them (11). Designing appropriate care plan parents, develop effective relationships is one aspect of cultural sensitive care for and mutual trust with the aim of satisfying meeting individuals’ needs. Healthcare parents in nursing practice (33). Foronda workers try to change the person’s believes that effective communication is perspective regarding care (8). Culturally an outcome of culturally sensitive care (8). sensitive care is more effective than Campinha-Bacote states that during general medical services (8, 40). The interactions with culturally diverse results of this study also is supported the patients, educated interpreters are required Leininger theory stating that negotiation for preventing problems in the with others is required for obtaining useful interpretation of diseases and medical results related to (1). terminology (34). Clegg believes that understanding is the basis of linguistic 4-1. Limitations of the study communication, thereby achieves an This study was based on the pediatric understanding between the patient and nurses' experiences and parents in Iran. nurse (17). Daily communication is an More studies using qualitative research in important part of nursing care (35). this area are suggested. Since the key to Communicating with sick children and improving the quality of care is

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