Cultural safety in motherhood: evidence from midwives and nurses in the multicultural context of Iran society

Introduction:  Delivery is a personal and emotional experience and one of the major events in women's lives (1) which is literally replete with women’s cultural experiences and beliefs (2). Therefore, any perception of pregnancy and childbirth and women's experiences needs an understanding of their culture, tradition and social values (3-7). Cultural safety involves understanding the concepts, respect, empathy, empowerment, confidence reinforcement, respect for personal rights, protection of human rights, and personal dignity (8-10). Diversity in Iran includes a wide range of religious, ethnic, linguistic, cultural elements (11). One of the provinces affected by such a cultural diversity is Northern Khorasan (12). The present study, therefore, was done to assess the knowledge, attitude, and performance of midwives and nurses regarding the cultural safety in motherhood. Methods:  In this cross-sectional descriptive correlational study, 104 midwives and nurses working in hospitals of North Khorasan were studied. The data collection instruments were a researcher-made checklist, performance observation, a three-part researcher-made questionnaire, the first part of which consisted of demographic information, the second part contained midwives’ and nurses’ knowledge, and the third part was concerned with the attitudes of midwives and nurses. Face and content validity were used to determine the validity of the test. However, to determine the reliability of the knowledge and attitudes sections, test-retest method was used, and for the performance section intra-rater and simultaneous observation methods were applied. The data were analyzed using descriptive and inferential statistical methods, as well as Pearson test running SPSS 21 statistical software, and setting the significance level lower than 0.05. Ethical considerations:  Having presented the objectives of the study to the participants with an emphasis on confidentiality of the research information, data collection was carried out anonymously, obtaining verbal informed consent of the participants. Results: The mean age and experience of the midwives and nurses were 30.84 and 5.57 years, respectively. Of the participants, 2.9% held Associate degrees, 95.2% had Bachelor’s degrees and 1.9% held Master’s degrees. As for midwives’ and nurses’ working shifts, 89.4% were working shift hours (three times) and only 2.9% of them were working on fixed shifts. 99 percent of participants were Shiites, 67.3% were married, 43.3% were Fars (Iranian majority ethnic group) and the rest of them were from other ethnic groups, and the majority of them (81.7%) were indigenous residents. Midwives’ and nurses’ mean score for knowledge was 4.32 out of 10 (undesirable), their mean score for attitude was 46.62 out of 60 (relatively desirable), and their mean score for performance was 101.13 out of 150 (relatively desirable). Correlation test showed a significant relationship between the scores of knowledge, attitude and performance of the participants (P 0.05). Discussion and Conclusion:  The results of present study indicated that knowledge and attitude scores of midwives and nurses about cultural safety was undesirable. Despite the low scores of midwives’ and nurses’ knowledge and attitude, a relatively desirable performance was observed as for their relationship with women. This may be as a result of work experience of most of the participants as well as their being indigenous residents. Having empathy and understanding of the situation of women and being aware of cultural issues of indigenous women, the participants also had a desirable performance providing the services. Studies have revealed that communication obstacles could impair the development of the caring relations (14-16); and that once health workers fail to identify such obstacles to intercultural communication, its inferior outcome will be inequality in care and feeling of stress (17). Hence, task allocation can, as much as possible, be done in such a way that those midwives and nurses who speak the same language as the delivering mother take care of her although for various reasons, including the lack of manpower, implementation of this proposed recommendation may face some obstacles. Modesty in communication with the patient, courteous addressing, openness, and eloquence are some of the components of optimal communication with patients (8). The present study displayed that only 36% of midwives and nurses sometimes offered services in accordance with the mothers’ culture. Nurses are morally obligated to provide care compliant with the patients’ culture (14). Studies have shown that when deciding on the use of obstetric services, women consider their own needs and preferences, health beliefs, and social and cultural factors (13); in fact, women use these criteria to judge the available services (19-18). This reflects women’s different perceptions of the quality of care (Haddad et. al, 1998). The role of quality in using the services is associated with peoples’ definition and assessment of the quality, which is to a large extent dependent upon their experiences of the health care system. Previous experience or hearing from friends and family about staff’s negligence in the maternity unit, malpractice, discrimination against ethnic groups, lack of respect for traditional beliefs, language barriers, lack of accountability (20), and ignoring the views of patients can prevent women from referring to these centers (21). Thus, mere existence of the services will not suffice. Services ought to be of high quality and meet the needs of the mothers. Moudi (22) found that when hospital services are as much as possible consistent with the expectations and the social-cultural characteristics of the society, mothers will take advantage of these services to benefit more from the positive aspects of progress and development. Although the participants in this study showed a relatively desirable performance concerning cultural safety, it is recommended that some careful education planning be devised for students, midwives, nurses, and other health care providers regarding the cultural safety in accordance with the new approaches of population policies and cultural diversity of Iranian society.  Please cite this article as:  Reihani M, Keshavarz Z, Vedadhir A, Zaeri F. Cultural safety in motherhood: evidence from midwives and nurses in the multicultural context of Iran society. Med Ethics J 2016; 10(36): 55-64.