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Background

Discuss about the Interviewing Culturally Deverse Group for Ethical Obligation.

Interviewing is one of a tedious as well as an interesting job that requires a large number of attributes in the interviewer. The interviewer needs to be patient, clear in his goals, capability to handle intense situations and many others (Young et al., 2017). Therefore, every individual who needs to dawn the hat of an interviewer needs to practice a set of skills that are extremely important for conducting interviews successfully without creating any legal or ethical obligations. Another challenge that needs to be tackled successfully by the interviewers is the cultural barriers that develop when interviewers need to interview individuals who are belonging to different cultural backgrounds (Hole et al., 2015). Each of the cultures have their own traditions, preferences, inhibitions, communication styles and many others which need to be cared for the interviewers.  Hence, proper preparation and development of cultural knowledge about the interviewee needs to be adopted by the interviewers so that they can achieve success in the goals. The present assignment will mainly put importance to the critical analysis of different interview aspects which interviewers should be kept in mind while preparing or taking the interviews.

Due to the increasing incidence of diabetes rate in the indigenous community of the nation, I was assigned the duty to interview a client and his families. The client was suffering from hyperglycemia and foot ulcers with symptoms like ketone in urine, increased hunger, thirst and others. After the entire treatment was done, my mentor requested me to take proper interview of the patient and his family to identify the social and psychological determinants of health so that the disorder can be controlled. I had to identify the social determinants of health that are contributing to the disorder in the patient and among his family so that i can prepare proper discharge plan. For this, I had to take of all the members individually to develop ideas about their health literacy and feelings with the disorder. This was done to develop ideas about their lifestyle factors and about the eating habits of the patient and his family members. This was my second interview, as I had conducted one more interview before. Moreover, I had to take interview of culturally diverse people and therefore, I was quite interested about this new opportunity. While I tried my best to be humble with the patient from the native background, I felt that somehow he and his family members did not like certain activities or my speech. Although they started happily on the first note but as the interviews started to continue, I realized that they were becoming uncomfortable and started ensuring me in yes or no rather than discussing the issue with me openly which they were doing initially. I could feel that they were gradually withdrawing from the interview and wanted to complete it anyhow. Because of this, the main objective of the taking of the interviews failed miserably. Although I tried to make them feel comfortable, they were trying to complete the interviews early. I noticed that although they were very interested to talk with healthcare professionals at first but with gradual passing of time, they were feeling confused with my words and were not responding to me properly. They kept a blank face and looked at me as if they could not relate to about what I was asking them. However, they could not understand what to say and were often seen to go off tracks in their answers and then got lost in their discussions. I provided them enough time to get back in the context without interrupting them. Still, I failed miserably to get back the correct set of answers that I was expecting from them. The interviews failed miserably and I was severely criticized by my nursing mentor as she expected me to perform better in the interviews with the expected results.

Challenges in Conducting Interviews

Before conducting the interviews, I was quite confident about my approaches as my previous interview with non-native patient in the hospital went quite well. The success of the previous interview had helped e to gather enough courage to take interview of the native people of the nation, as I believed that the differences would not be much enough to make me fail the activity. However, although I started the interview with the patient and his family members in a good note, I started to feel that they were no more feeling comfortable with me. I tried to engage them in informal talk so that they can feel stress-free about the procedure. However, not all these helped in developing the situation. I was feeling hopeless, as I could not develop an idea to make the interviewees adhere to the interview. Moreover, when I saw that my interview was not going on successfully, I became nervous as I felt that I was not able to conduct the interview successfully. I got demoralized as well as confused at the same time as I could not understand where I was making the mistake that resulted in the occurrence of situations. While conducting interviews, I also realized that I was not getting the expected answers. I felt stressed as the time allotted for the interviews were nearing towards end but I was not able to gather the information that I needed to know. All this made me very upset, as I could not understand why the entire interview failed miserably. I was quite demotivated because I could not understand what mistakes I made and how to develop the mistakes for better interviewing the second time that would help me to gather the exact information that I wanted. I could not understand how I could develop their discharge plan, as I would have to fill the recommended interventions for them and without knowing the determinants, I could not develop any discharge plan.

In the step, I needed to reflect what were bad and good about the entire episodes. The bad part of the entire incident was that the time that were allocated for conducting of the interviews were wasted entirely and the patient got stressed. I was severely criticized by the nurse in charge of the healthcare center as he had lot of faith on my ability to complete the task successfully. I really got upset for letting his expectations down. Moreover, I was also apprehensive that such a disastrous interview would make me lose the scope of conducting such interview again as none of my seniors would have trust on my ability. Moreover, my interview may also have offended the native family and I was afraid that they might complain against me that might affect my career as well as my nursing ideal. They native patient and his family members might also perceive me in a negative way for which they might not want to participate in any care plans by me or in any interviews with me. This interview destroyed my self-confidence about my skills and abilities of nursing and I feared that this situation may affect my further healthcare activities as well. However, there are also positive aspects that remain associated with incident. This incident clearly helped me to realize that I was culturally incompetent in conducting interviews with people from other cultural background. This incident helped me to realize that there are certain important aspects that I did not correctly conduct in the interview. I realized that I have to critically reflect in the different moments of the interview and find out the main reasons that had made the patient and his family members withdrawn from the interview. I would also need to develop ideas why they seemed lost in the interview and cannot follow my instructions. These interviews helped me to realize that I need to learn how to take interviews in a culturally competent manner and also helped me to realize that interviews conducted between the natives and non natives are entirely different and proper framework should be adopted to fulfill that.

Reflection and Analysis

The next step is the analysis step where the individual need to describe the senses that he can make out of the situation. From the analysis of the entire situation, it has been seen that there are many mistakes that I made in the interview that needs to be corrected by me. In order to find out my mistakes I jotted down the entire incidents in a point manner and then searched for evidences in the journal articles to identify the mistakes that I made. After searching out interview protocol, I came across certain papers that helped me to develop ideas about the mistakes that I have made. The first mistake that I made is that I did not take any initiative to understand whether the patient is having clear idea about what is asked about and why the information is important. The patient and family members had different understanding about what the interview was about and this affected the level of participation that they were willing to ensure in the interview (Lyford et al., 2018). Therefore, it is extremely important for the interviewer to gather knowledge about the willingness of the patients and the aspects they know about discharge plan necessities. In this case, I should have taken an initiative to make the patient understand the significance of social determinants of health on diabetes and the ways this may affect life of their next generations. After making them understand the importance and getting assurance from them for participation, I should have conducted the interview. The mistake I made was that I started the interview only stating that rationale without discussing the significance of the interview in detailed manners. Another very important aspect that I did not follow while questioning the elders is appropriate method of reciprocity. Due to my inappropriate cultural knowledge, I asked direct questions to the patient and his family members as I had done with the non-native people in the hospital in my previous interview. I had no idea that native people tend to prefer a less direct approach to the communication. Therefore, my direct questioning to them regarding their lifestyle and eating habits was taken as confronting as well as offensive to them. Therefore, although they started the interview in the happy mood but they did not like my interview procedure. However, their culture prevents them to be direct in expressing their noncompliance and therefore they did not deny continuing the interview (Dawes et al., 2017). The researchers are of the opinion that the interviewers should adopt a customary way of seeking information from the aboriginal adults that would be established on the two-way exchange volunteering information on their own (Kendall & Barnett, 2015). One of the researchers have also found out that although aboriginal individuals feels comfortable in providing general information through direct questioning but detailed personal information can be only got through indirect questioning. Another important aspect of reciprocity in interviewing is the right body language of the interviewers as non-verbal communication skill of the interviewers hold great importance in communication with native people. In the western culture, direct eye contact is very important as individuals who do not provide eye contact is perceived to be hiding something or gives a signal that the person cannot be trusted (Kendell & Barnett, 2015). Therefore, while I was communicating with the native people, I tried to maintain eye contact with them so that they do not feel disrespected or low on self-esteem while communicating. However, this was negatively perceived as native people consider eye contacts to be rude and inappropriate method of communication. Eye contact is considered by them to be a symbol of disrespect, rudeness and even a method of aggression. Another mistake that I conducted was that I perceived silence in a way that was entirely different from their methods of interpreting silence. While interviewing, the native patient and his family members had long periods of silence between interactions. Westerners feel that silence only occurs when there is a lack of understanding and therefore, it should be immediately filled (Hamilton et al., 2017).  Following this aspect, I tried to fulfill the gap by either helping the elders to understand the question or changing the question to other topics to prevent them feel demoralized. The native people negatively perceived this entire incident. From the articles, it was seen among native societies, lengthy periods of silence are considered as norm and therefore the native people expect such silence in different interactions.  Such silence is found to be extremely important during information sharing and information seeking. Researchers have also stated that native people use silence to listen and allow for consensus (Flicker et al., 2015). Therefore, they have stated that the interviewers should never interpret positive use of silence as lack of understanding of the interview questions or agreements.

Lessons Learned

While conducting interview, I also made a number of mistakes. The first mistake was that I asked questions to them in a strictly professional manner that confused them and they felt shy or uncomfortable, as they could not understand why a stranger is asking them questions. Researchers are of the opinion that rapport building and practice narratives are very important while interacting with the native people. Researchers are also of the opinion that in order to develop rapport, it becomes extremely important for the interviewers to incorporate a bidirectional approach to information sharing. By this, the researchers meant that the interviewer should also share some personal information about himself or herself to strike the first chord of rapport building (Crooks et al., 2017). Moreover, another mistake that is made is my lack of preparation before staring interviews with the native patient. The use of proper language that aligns with the language, use of words and tones of that of the aboriginal people is of high importance in the interviewing process so that they do not feel that the entire interview is alien to them and that they cannot align with the interview. This can be explained with the help of an example. When I used the term “promise” in the way “Do you promise to tell me the truth?”, the entire sentence was not well perceived by the patient and he  looked at me with  a blank expression. Although, I was not able to understand the reason, later it was revealed by a colleague that they relate the word “promise” with certain aspects like when girls are fixed for marriage to their men, they use the term promise in this sense. Moreover, the use of the word truth was negatively perceived by them as they relate the word “truth” mostly in the form of blaming someone rather than taking in a casual way. Therefore, care should be taken while communicating with native pateints as they may not use many words or sentence in casual tone like that of the non-natives (Catherine et al., 2016). The third mistake that I made is repeated intervening of the information that they were providing among themselves. Whenever, the patient got stuck with any part of their discussion, I thought that intervening and helping him with words and thoughts would help them to catch up with their thought and thereby express himself successfully. However, this had negative impacts as the patients got confused and did not want to continue with the interview.  The  patient lost his flow and changed his track of discussion that made him lost their focus. As a result, I could not get back the information. Researchers are of the opinion that narrative based framework is suitable for eliciting information from the native people. Direct questioning should be avoided as that becomes a form that is unfamiliar as well as intrusive to native communities and increase their stress levels (Crooks et al., 2015). Use of open-ended prompts is acceptable accompanied by the notion of not interrupting the flow of information, not asking direct questions and allowing them completely to speak.

Conclusion

Conclusion:

In this step, the individual should determine what steps he or she should have taken in the depicted event. The first step that I should have taken is to educate the patient and his family members about discharge planning procedures. This would have helped them to understand the rationale of the interview that would have ensured better compliance and adherence with the interviewing procedures. The second initiative that I would have taken is to prepare myself and develop cultural knowledge about aboriginals. I should have gone through articles or recommendations of interviewing process with them.  I should not have engaged in direct questions but should rather indulge into a narrative discussion session with indirect questioning and interactions rather than direct questioning. I should not perform any eye contact and should not interrupt ay silence that occurs while interviewing. I should properly prepare myself with adequate cultural knowledge so that none of my activities upset them. While conversing with them, my first priority would be developing rapport with them through bidirectional approach so that effective communication can be ensured. Moreover, proper use of words and statement that are common to the native children should be used. Moreover, in order to gather information about their lifestyle, open-ended prompts can be used where children should not be interrupted and allowed to speak without disturbance.

I have to develop interview skills that are culturally-competent. Before interviewing the individuals, I need to develop knowledge about the culture of the people whom I need to interview. This can be developed through learning of different evidence based articles where recommendations are provide by the researchers. Moreover, various articles are found on the internet that reveals about the cultural traditions, preferences and inhibitions about the different cultures. This would help me to be confident about my interviewing approach and thereby help me to prevent any sort of mistakes while interviewing. Therefore, from now onwards, I will take initiatives that would help me to recognize the different personal bias I have and thereby manage the personal biasness effectively. I will develop knowledge of different cultural groups as well as the differences between them. I also need to develop understanding of the ways by which the people from diverse backgrounds can feel comfortable that would help them to disclose their feelings effectively.  All these would help me to develop trustworthy relationship with the interviewees, as they would feel respected. These would help them to reveal information without developing any concern or dilemma.  By developing cultural competence, I would be able to interview persons effectively and seek information to meet the goals.

Conclusion:

From the above discussion, it becomes quite clear that cultural incompetence may result in failure of the interviews that an interviewer may want to take on culturally diverse people. It is thereby important to gather knowledge about the people, develop ideas about their communication styles, and gather information about their customs and traditions. All these would help to make the interviews successful and fruitful.

References:

Catherine, N. L., Gonzalez, A., Boyle, M., Sheehan, D., Jack, S. M., Hougham, K. A., ... & Waddell, C. (2016). Improving children’s health and development in British Columbia through nurse home visiting: a randomized controlled trial protocol. BMC health services research, 16(1), 349.

Crooks, C. V., Burleigh, D., Snowshoe, A., Lapp, A., Hughes, R., & Sisco, A. (2015). A case study of culturally relevant school-based programming for First Nations youth: Improved relationships, confidence and leadership, and school success. Advances in School Mental Health Promotion, 8(4), 216-230.

Crooks, C. V., Exner-Cortens, D., Burm, S., Lapointe, A., & Chiodo, D. (2017). Two years of relationship-focused mentoring for First Nations, Métis, and Inuit adolescents: Promoting positive mental health. The journal of primary prevention, 38(1-2), 87-104.

Dawes, G., Davidson, A., Walden, E., & Isaacs, S. (2017). Keeping on country: Understanding and responding to crime and recidivism in remote Indigenous communities. Australian Psychologist, 52(4), 306-315.

Eades, D. (2015). Taking evidence from Aboriginal witnesses speaking English: Some sociolinguistic considerations. Precedent (Sydney, NSW), (126), 44.

Ferguson, M., Brown, C., Georga, C., Miles, E., Wilson, A., & Brimblecombe, J. (2017). Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia. Australian and New Zealand journal of public health, 41(3), 294-298.

Fitzpatrick, E. F. M., Macdonald, G., Martiniuk, A. L. C., D’Antoine, H., Oscar, J., Carter, M., ... & Elliott, E. J. (2017). The picture talk project: starting a conversation with community leaders on research with remote aboriginal communities of Australia. BMC medical ethics, 18(1), 34.

Flicker, S., O’Campo, P., Monchalin, R., Thistle, J., Worthington, C., Masching, R., ... & Thomas, C. (2015). Research done in “a good way”: the importance of indigenous elder involvement in HIV community-based research. American journal of public health, 105(6), 1149-1154.

Hamilton, G., Brubacher, S. P., & Powell, M. B. (2016). Expressions of shame in investigative interviews with Australian Aboriginal children. Child abuse & neglect, 51, 64-71.

Hamilton, G., Brubacher, S., & Powell, M. (2017). The effects of practice narratives in interviews with Australian Aboriginal children. Investigative Interviewing: Research and Practice, 8(1), 31-44.

Hamilton, G., Powell, M. B., & Brubacher, S. P. (2017). Professionals' perceptions regarding the suitability of investigative interview protocols with Aboriginal children. Australian Psychologist, 52(3), 174-183.

Hole, R. D., Evans, M., Berg, L. D., Bottorff, J. L., Dingwall, C., Alexis, C., ... & Smith, M. L. (2015). Visibility and voice: Aboriginal people experience culturally safe and unsafe health care. Qualitative health research, 25(12), 1662-1674.

Kendall, E., & Barnett, L. (2015). Principles for the development of Aboriginal health interventions: culturally appropriate methods through systemic empathy. Ethnicity & health, 20(5), 437-452.

Lyford, M., Haigh, M. M., Baxi, S., Cheetham, S., Shahid, S., & Thompson, S. C. (2018). An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia. International journal of environmental research and public health, 15(2), 337.

Young, C., Tong, A., Gunasekera, H., Sherriff, S., Kalucy, D., Fernando, P., & Craig, J. C. (2017). Health professional and community perspectives on reducing barriers to accessing specialist health care in metropolitan Aboriginal communities: A semi?structured interview study. Journal of paediatrics and child health, 53(3), 277-282.

Young, C., Tong, A., Gunasekera, H., Sherriff, S., Kalucy, D., Fernando, P., & Craig, J. C. (2017). Health professional and community perspectives on reducing barriers to accessing specialist health care in metropolitan Aboriginal communities: A semi?structured interview study. Journal of paediatrics and child health, 53(3), 277-282.

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