Many nurses might regard a patient who refuses to take a certain medication, constantly has a roomful of visitors, or demands that a family member feeds him as noncompliant. However, nurses who dig deeper may discover these behaviors are a product of the patient’s cultural beliefs and values and deep-rooted ideologies that nurses can preserve or accommodate.
Providing culturally sensitive and competent nursing care may seem like a difficult task, especially when patients have cultural beliefs and practices that are dissimilar or unfamiliar to any type of nurse. Regardless of an individual’s cultural beliefs and practices, nurses have an inherent obligation to provide equal and ethical care to all patients.
The U.S. is expanding culturally at an unprecedented rate. According to a study published by the American Association of Colleges of Nursing, (more than a third) of the American population are individuals from racial and ethnic minorities.
It’s estimated that by the year 2043, they will no longer be the minority. Unfortunately, only 19% of RNs in the workforce are from racial or ethnic minority backgrounds and this disparity has presented a number of challenges in caring for a culturally diverse population.
The number of ethnically and culturally diverse groups is growing, and each has its own cultural traits. Additionally, some racial groups present unique health challenges specific to that group.
From triage to discharge, nurses spend an increasingly significant amount of time with their patients, making it critical for them to become culturally competent. Cultural competency is an important nursing skill in the health care sector that supports positive patient outcomes and improves medical research accuracy.
What is cultural competence?
In Transcultural Health Care: A Culturally Competent Approach, Dr. Larry D. Purnell, Ph.D., RN, FAAN, defines cultural competence as “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture.”
In other words, cultural competence is learning about how cultural differences may impact healthcare decisions and being able to modify care to align with that patient’s culture.
What kind of barriers are created by cultural differences?
There are many barriers erected by cultural differences, especially between nurses and their patients:
When nurses and their patients don’t speak the same language, providing quality medical care and making the patient feel comfortable and cared for can be exponentially more challenging. It can be difficult to inform a patient or be confident about consent given when the patient primarily communicates in their mother tongue. It’s also very common for patients who are bilingual to speak in their native language when they don’t feel well and are stressed or scared.
Many cultures have very different ways of thinking about healthcare and may have traditions that go against the grain of western medicine. For example, a Native American man may not want to be resuscitated or placed on life support. A woman born in Beijing may be resistant to taking prescribed medication for a condition and may want to use traditional Chinese herbal remedies and acupuncture. Healthcare providers who are unfamiliar with cultural traditions surrounding medical care may have difficulty connecting with the patient or the patient may not feel safe and recognized, which is key to treatment acceptance.
A different understanding of healthcare from culture to culture also affects health literacy. Individuals in some cultures may not be aware of certain health conditions or how to maintain their health on a day to day basis. When patients from different cultural or racial backgrounds have difficulty understanding healthcare practices, nurses have the important job of bringing them up to speed with diagnosis and treatment in a way that is sensitive to their cultural needs.
Many nurses have developed assumptions about different cultures over time, often because there was a fundamental lack of accurate education about that particular culture. Cultural assumptions and the lack of knowledge of culture can create unique challenges for both nurses and patients.
Watch the following video to know – what is culturally competent healthcare?
What are the steps nurses can take to provide culturally sensitive care?
There are many things nurses can do to provide culturally sensitive care to an increasingly diverse nation:
As with any social issue, the first step is awareness. You’re here, which means you have a degree of awareness about the need for culturally competent care. Many healthcare facilities and their staff, especially those in rural areas, may not be aware that the medical sector is in desperate need for culturally sensitive healthcare.
What you can do
As you strive to learn more about becoming a culturally sensitive nurse, let others know what you’re doing and why. Encourage your co-workers to provide more culturally competent care. Approach sharing awareness with openness and positivity, rather than from a critical point of view.
2. Avoid making assumptions
It’s important that nurses avoid making assumptions about cultures they aren’t familiar with. This can lead to a breakdown of trust and rapport between the nurse and their patient and reduce treatment acceptance.
What you can do
If you’re unsure about something, simply ask. Most people of different cultures will happily educate a healthcare provider who is willing to listen and understand their cultural differences. When asking questions, make sure your body language communicates openness and intent to truly hear the patient versus listening to respond.
3. Learn about other cultures
As a nurse, part of your responsibility to your patient is to learn what you can about them. Often, this is reduced to their medical history, their list of medications, and their current symptoms. In reality, healthcare only reaches its full potential when the whole patient is considered, including their family, their day to day life, and their culture.
What you can do
Think about the different cultures you’ve encountered in your healthcare career, as well as the cultures that are within your community. Make an effort to learn about those cultures by becoming immersed in them. Visit the area where that culture is dominant and read about the culture from reputable books and online sources. Question any assumptions you have about cultures that are not your own and make an effort to either prove or disprove the assumption and turn it into knowledge.
4. Build trust and rapport
It’s essential for nurses to build trust with their patients, regardless of ethnic or racial backgrounds. However, treating culturally diverse patients require a heightened level of trust to be established, which can become even more difficult when there’s a language barrier.
What you can do
Ask for a translator, but don’t be tempted to look at the translator when speaking. Look at the patient and speak to them as if no language barrier existed. The translator will relay the information to the patient and then their response back to you. Body language and eye contact become much more important, so be sure to display open and kind body language and look the patient in the eyes when speaking to them or their family members.
5. Overcome language barriers
Language barriers exacerbate all other challenges nurses face when providing care for culturally diverse patients. To effectively communicate with a patient to ask them about their health history or to educate them about a procedure, the language barrier must be broken in some way.
What you can do
Ask your facility if a translator is available. Most hospitals do have translators on-staff, but a smaller doctor’s office may not. Explore translation technology — while it may not be 100% accurate, it can help you better understand your patients and your patients better understand you. Use pictures or hand gestures to communicate when necessary, and remember to be patient. Language barriers are frustrating for both you and your patient, but your patient is at a distinct disadvantage.
6. Educate patients about medical practices
It’s critical that every patient, regardless of their cultural or racial background, give informed consent for any medical procedures. If they are unfamiliar with a medical practice, nurses often have the job of explaining in detail why the procedure is needed and what to expect during and after the procedure. Additionally, patients from some cultural backgrounds need further education on how to manage at home on their own. They may need to blend new practices with cultural traditions to maintain their health, and education is a key component of that process.
What you can do
When communicating with a patient, ask them to repeat back to you what you said, in their own words. If there’s a language barrier, a translator can help. Essentially, this will help you determine how much of what you are saying has been understood and how you might be able to change the way you communicate to improve the patient’s understanding. Continue until you are reasonably confident that the patient has enough clarity about the next step to willingly and knowingly consent to it.
7. Practice active listening
Many people have a bad habit of asking a question and then listening to the answer for the sole purpose of planning what they are going to say next — instead of actually hearing, considering, and validating the person speaking. Active listening in the healthcare community is imperative, especially when individuals of different racial or cultural backgrounds are involved. It’s important that patients feel heard and validated, particularly when they are in a vulnerable position.
What you can do
After you ask your patient a question, take the time to really listen. Sit down with them, make eye contact, or gently place your hand over theirs. Reassure them that you’re there and ready to hear what they have to say. If you need clarity, ask. If your patient becomes frustrated by a language barrier, remain calm and let them know it’s okay to take their time when communicating with you. Repeat back to them what they said in your own words, so they can also have confidence that you’ve understood them.
The trend in health care is to allow for more liberty in patient choices and involvement, as well as the ability to carry out their normal practices as much as possible.
Sensitive cultural care is not just a phenomenon that takes place when occasionally encountering foreigners in the hospital or providing care to someone of a different religion. It is the result of the awareness that everyone belongs to a unique subculture based on beliefs and practices and the mindful consideration and space given to each and every patient. The conscientious nurse can affirm, respect, and nurture all patients through deliberate awareness, acceptance, and asking.
“The crucial differences which distinguish human societies and human beings are not biological. They are cultural.” – Ruth Benedict