Current trends of an increasingly multicultural society emphasize the need for nursing education programs that effectively address cultural issues. To understand the diverse cultural backgrounds of clients, nurses must strive to be culturally competent (Marcinkiw 2003). Cultural competence requires the building of cultural awareness, knowledge, skill, encounters, and desire in the nurse. Clients will feel respected, valued, and have a greater desire to achieve mutually agreed upon health care goals if the nurse is culturally competent. The purpose of this essay is designed to show the cultural competence in the nursing profession by providing a guide that is useful for implementing cultural sensitivity in nursing education and practice.
Diversity. It is a word that means something different to each and every person. Bacote, 2003 asserts that the changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged health care providers and organizations to consider cultural diversity as a priority.
However, health care providers must realize that addressing cultural diversity goes beyond knowing the values, beliefs, practices and customs (Bacote, 2003). In addition to racial classification and national origin, there are many other faces of cultural diversity. Religious affiliation, language, physical size, gender, sexual orientation, age, disability (both physical and mental), political orientation, socio-economic status, occupational status and geographical location are but a few of the faces of diversity (Bacote, 2003).
I would like to share thoughts concerning the complexities involved in caring for people from diverse cultural background; I came from different country myself.
My understanding of whole Health care system in Australia was a lot different from past experience in my country of origin. As most foreigners it was just a matter of time before I could get use to the system of medical care. And skills like: listening, understanding, respect for my belief systems and ability to build trust were very important to me. Now I could tell that there is range of cultural behaviors and the need to understand people’s actions from their own cultural perspective in health and illness.
Cultural values give an individual a sense of direction as well as meaning to life.
These values are held on an unconscious level. There is a direct relationship between culture and health practices (Bacote, 2003). In fact, of the many factors that are known to determine health beliefs and behaviors, culture is the most influential (Bacote, 2003).
Recently I heard an excellent paper where cultural supervision was discussed (Westerman 2004). There, I become more acutely aware of the importance of cultural differences vis-à-vis Aboriginal societies. Although I had been aware of these differences before, I now came to see that there were many cultural subtleties that require specialist knowledge and approach. According to Driscoll (2007:80) there is another kind of knowledge that can only develop when one has direct and deep experience of another cultural group. Cultural groups can be ethnic groups, or groups we sometimes refer to as sub-cultures (Driscoll & Yegdich 2007).
A humanistic and scientific area of formal study and practice in nursing is called transcultural nursing, it is focused upon differences and similarities among cultures with respect to human care, health, and illness based upon the people’s cultural values, beliefs, and practices, and to use this knowledge to provide cultural specific or culturally congruent nursing care to people (Leininger 1991).
Leininger notes the main goal of transcultural nursing is to provide culturally specific care. But before transcultural nursing can be adequately understood, there must be a basic knowledge of key terminology such as culture, cultural values, culturally diverse nursing care, ethnocentrism, race, and ethnography.
Singelis (2005:4-5) believes that to be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes. Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points (Singelis 2005:5). Cultural competence means to really listen to the patient, to find out and learn about the patient’s beliefs of health and illness. To provide culturally appropriate care we need to know and to understand culturally influenced health behaviors (Singelis 2005:5).
Also Singelis (2005) highlights that to be culturally competent the nurse needs to learn how to mix a little cultural understanding with the nursing care they offer. In some parts of the Australia culturally varied patient populations have long been the norm. But now, even in the homogeneous state of Queensland where we reside, we are seeing a dramatic increase in immigrants from all over the world. These cultural differences are affecting even the most remote settings.
Since the perception of illness and disease and their causes varies by culture (Germov 2005: 155), these individual preferences affect the approaches to health care. Culture also influences how people seek health care and how they behave toward health care providers. Furthermore Germov (2005:155) asserts that how we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of health care (Germov 2005: 154). These issues show the need for health care organizations to develop policies, practices and procedures to deliver culturally competent care (Germov 2005).
Developing culturally competent programs is an ongoing process. There seems to be no one recipe for cultural competency. It’s an ongoing evaluation, as we continually adapt and reevaluate the way things are done. For nurses, cultural diversity tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we care.
Meyer (1996) describes four major challenges for providers and cultural competency in healthcare. The first is the straightforward challenge of recognizing clinical differences among people of different ethnic and racial groups. The second, and far more complicated, challenge is communication. This deals with everything from the need for interpreters to nuances of words in various languages. Many patients, even in Western cultures, are reluctant to talk about personal matters such as sexual activity or chemical use. How do we overcome this challenge among more restricted cultures (as compared to ours)? Some patients may not have or are reluctant to use telephones.
We need to plan for these types of obstacles. The third challenge is ethics (Meyer 1996). While Western medicine is among the best in the world, we do not have all the answers. Respect for the belief systems of others and the effects of those beliefs on well-being are critically important to competent care. The final challenge involves trust (Meyer 1996). For some patients, authority figures are immediately mistrusted, sometimes for good reason. Having seen or been victims of atrocities at the hands of authorities in their homelands, many people are as wary of caregivers themselves as they are of the care.
Holland, Jenkins, Solomon and Whittem (2003) assert that in a multicultural society it is important for nurses to consider how to preserve the individual patient’s social, cultural, spiritual, religious and ethical needs in order to help the patient understand, agree and cooperate with any planned care. There are many traditions and beliefs associated with health and illness that can alter a person’s behavior when they become ill and the nurse must seeks to understand how this may be observed in their patients (Holland, Jenkins, Solomon and Whittem 2003).
This discussion has highlighted importance of cultural diversity as a priority and that it has many other faces in life. It is clear that there is a direct relationship between culture and health practices. As individuals, nurses and health care providers, we need to learn to ask questions sensitively and to show respect for different cultural beliefs. Most important, we must listen to our patients carefully. The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other’s perspective. Therefore cultural diversity tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we care.
Bacote, C.J. (2003) Many Faces Addressing Diversity in Health Care. Online Journal of Issues in Nursing (Vol. 8:1-2). Retrieved from: http://www.nursingworld.org/ojin [05.05.07].
Driscoll, J. & Yegdich, T. (2007). Practicing Clinical Supervision. A Reflective approach for health care professionals (2d ed.). Bailliere Tindall. Elsevier.
Holland, K., Jenkins, J., Solomon, J. and Whittem, S., (2003). Applying the Ropper Logan. Tierney Model in Practice. Churchill Livingstone.
Germov, J. (2005). Second Opinion. An Introduction to Health Sociology (3rd ed.). Oxford.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38(2), 55-66. Retrieved from: http://www.culturediversity.org [05.05.07].
Marcinkiw, K. L. (2003). Nurse Education Today. 23(3), 174-182. Retrieved from: http://www.sciencedirect.com [05.05.07].
Meyer, C.R. (1996).Medicine’s melting pot .Journal for Primary Care Physicians (79:5-5). MinnMed.
Singelis, T. M. (2005). Teaching about culture, Ethnicity and Diversity: Exercises and Planned Activities. London: Sage Publications.
Westerman, T. (2004). The value of unique service provision for Aboriginal people- the benefits of starting from scratch. The Mental Health Services. (Sep.1-3) Conference Inc. of Australia and New Zealand.