It’s more of a case of reacting when a problem occurs, unfortunately you can’t really take preventive action, it’s more dealing with the problems as you meet them (GP of Moroccan female patient). Some health care providers remark that their own structured working methods do not fit in with the families’ ways of working or MLN8237 in vivo perceiving the situation. I keep trying to see whether it’s possible to talk about the possibility that things might be coming to an end. After all, it’s typically Dutch to want to arrange things and, in some sense, to say goodbye ahead of time. The Dutch are quicker to do that, Inhibitors,research,lifescience,medical often they suggest something

themselves, like shouldn’t we put a bed downstairs. And then I order Inhibitors,research,lifescience,medical it. With this family you have to be much more careful with everything, they need time to think it over (nurse of a Moroccan male patient). In addition, care providers say that it can be difficult to come to any arrangements in families with a Turkish or Moroccan background. For example, some people have a lot of relatives at home, others don’t. Some people don’t always open the door or answer the phone, and sometimes things are mistranslated. However, sometimes it goes really well and Inhibitors,research,lifescience,medical there’s a close working relationship between various care providers and the relative who

is the main point of contact. We appointed one person to be the main point of contact, her sister. She’s a bright girl, I know her well as she suffers from stomach problems and so I’ve seen her a lot. She was going to help as her mother still hardly speaks any Dutch (GP of Moroccan young female patient). Avoiding shameful Inhibitors,research,lifescience,medical situations Care providers realise that shame is an important issue for many patients and their families; shameful situations need to be avoided. Some care providers, however, find certain social rules irritating, like not taking a proffered hand or the women leaving room when male visitors arrive. Doctors notice that the fear of shameful situations

can put constraints on professional care and certain types of medical examination. I noticed that I was carrying out fewer physical examinations than Inhibitors,research,lifescience,medical I would with someone with a Western background, say. Actually, I don’t think that’s right, so now I do what I normally would, I want to look at her stomach, I have to sense what she finds acceptable or not, and what I think is medically necessary and then find a happy medium (GP of Moroccan female patient). Nurses also experience constraints on care, but try, nonetheless, to take why feelings of shame into consideration. Often, their bond with the patient and the family grows stronger as time goes by and they increasingly become a trusted figure both for the patient and the family. District nurses sometimes come initially just for specific technical advice and then slowly grow into a situation where they are also allowed to give physical care as well. So, at first, he looked after his own personal care.