Cultural Competence In Nursing

Introduction Cultural competence in nursing refers to our ability to relate to patients within the context of their own cultural values (DeNisco & Barker, 2013). According to Purnell (2005), one aspect of cultural competence is “demonstrating knowledge and understanding of the client’s culture, health-related needs and meaning of health and illness,” (p. 8). Furthermore, cultural sensitivity means the nurse will avoid imposing one’s own beliefs or cultural norms of health or illness onto the patient. This is imperative in our practice for a mutually respectful, trusting, and therapeutic relationship to develop. The nurse practitioner who possesses cultural competence will provide optimal individualized care to every client.
With respect
to communication, cultural sensitivity also requires an awareness of how ethnicity influences what is heard, read and understood by members of different cultural groups. The language barrier is frequently identified in research literature as a chief impediment to effective health care (Berry-Caban & Crespo, 2008). DeNisco & Barker (2013) recognize that Hispanics are now the largest minority population in the United States. Consequently, an understanding of their culture and communication features is particularly relevant to today’s advanced practice nurse. Recommendations were established in 1999 for health systems to provide culturally and linguistically appropriate services (CLAS), (DeNisco & Barker, 2013). The national standards were updated in 2013 to 15 criteria, 5 of which are specific to language, from documentation of the client’s preference to provision of interpreter services (Office of Minority Health, 2015).
The purpose of this paper is to identify effective techniques for the practitioner to utilize when communicating with the Hispanic patient. The scholar will reference one journal article in particular as the primary reference for this work. Choice of journal and respective article was influenced by the scholar’s current position as a clinical instructor for baccalaureate nursing students on a medical-surgical hospital unit. Both the nursing school and hospital are located in southern Colorado, which is the eighth state in the U.S. with the largest Hispanic/Latino population, according to Census Bureau statistics (2010).
Summary of Article
Darlene Hicks, MSN, RN, authored the article “Cultural Competence and the Hispanic Population” for the journal MEDSURG Nursing.
The article begins with statistical data about the leading causes of illness and death for the Hispanic population. The Centers for Disease Control and Prevention identifies these as “heart disease, cancer, accidental injuries, stroke and diabetes” (OMH, 2009, para. 7). The practitioner must take into account how each of these may present differently in Hispanics than in other cultural groups, to individualize care planning. The article goes on to describe the most important cultural influences for the Hispanic/Latino which are briefly laid out in the following paragraphs.
Family
The patient of Hispanic or Latino descent will not experience health issues alone. Family is highly valued over and above the needs of the individual in Hispanic culture (Hicks, 2012). Immediate as well as extended family will often be present during each encounter with a health care provider. It is not uncommon for the patient to need extended periods of time to consult with adult family members before making important health decisions.
When hospitalized, the Hispanic patient will likely be doted on by a constant stream of family members. Some close family friends may expect to be treated no different than blood relatives when they visit. The nurse practitioner should not assume that her assessments and other patient interactions with will occur
privately.
Respect
Respect is extremely important to all adult members of the family, and traditional gender roles tend to endure among Hispanics. Hicks (2012) reminds that reader that showing deference to others based on gender, age, social position and authority is also customary. During the first contact with the patient and family, the nurse practitioner should use formal greetings and titles to avoid unintentional disrespect. It may also be more difficult for the Hispanic patient to be open with a practitioner of the opposite gender.
Religious Beliefs
Spiritual faith is a central aspect of Hispanic culture. Many are Catholic and regular attendance at Mass, receiving communion and reciting daily prayers or the Holy Rosary may be sacred rituals. Hospitalized patients may wear religious medals or amulets and be reluctant to remove them for diagnostic procedures. Anointing of the Sick will likely be requested as the final sacrament for a Hispanic/Latino who is nearing death.
Health Beliefs The Hispanic patient may view the use of folk remedies or holistic healers as equally important to modern medical treatments. Elders are valued for their experience and advice; even serious health concerns may be taken to them first, before help is sought outside the family. Balance and harmony are fundamental to health maintenance for the Hispanic, whereas disease is believed to be an imbalance between “hot” and “cold” factors (Hicks, 2012). The goal of health care is to return to a state of synergy, thus, followers of Hispanic folk medicine will treat “hot” and “cold” illness with the respective opposing temperature therapy. Women within a Hispanic family will take charge in the event of a death. Extended family is immediately present and involved, however, men will not participate in care of the body. The church family often becomes a major source of support for the family as they grieve.
Communication
Conversing with a non-Hispanic nurse practitioner may be daunting to a Hispanic/Latino patient not fluent in English.
The patient may give audible and visible signs of agreement, appearing to fully comprehend all that is said. In actuality, imperative questions may not be asked due to deference and respect for the practitioner’s position of authority (Hicks, 2012). If immediate family is not bilingual, it is important to provide properly trained medical translators; preferably, of the same gender as the patient, per Hicks (2012). Conversation may be quite animated as emotional expression is characteristic of Hispanic/Latino families.
The author advises practitioners to engage in active listening, especially when the patient speaks of family, while consciously avoiding the appearance of being rushed. Beginning with friendly “small talk” is also expected in Hispanic culture and helps to develop a more personal relationship (Hicks, 2012). According to Hicks, close physical proximity to the patient and indirect eye contact also show respect during conversation. As a result, the Hispanic client may feel greater trust and confidence in the nurse practitioner and share more important, intimate health information (Hicks,
2012).
Application to Practice The health care consumer in the U.S. is becoming culturally diverse faster than the health care workforce. It is inevitable that practitioners will care for clients whose cultural values differ from one’s own. Including culturally-specific interventions in the care plan honors the patient’s values and demonstrates understanding of deeply-held beliefs. Acute care nurse practitioners (ACNPs) will likely encounter situations involving death and dying, with patients of other cultures. The seriousness of the topic requires that extra care be taken to avoid offending or alienating the patient and family. Interventions must be modified to provide care in a culturally sensitive way. Initially, the practitioner will establish rapport and begin to cultivate a personal relationship with all members of the family unit. Time spent with the Hispanic patient and family should always be unhurried. Genuine caring must be demonstrated for open communication and mutual trust to develop.
Addressing the appropriate head of household with important information is also key to maintaining respect; it may mean directing conversation to someone other than the patient. Though the male is typically the dominant figure in a Hispanic/Latino family, care must be taken to avoid stereotyping. The maternal role is not minimized even when the male is clearly the chief decision-maker. Rather, women are a vital source of nurturing and familial well-being. The desire to understand the prevailing family model should be clearly communicated up front. (www.culturediversity.org/hisp.htm)
Once a comfortable intimate relationship with the Hispanic patient and family is in place, difficult topics may be approached. As always, the practitioner must ensure essential family members are present for support and consultation with the patient. Beginning with a discussion and exploration of spiritual beliefs may be a helpful segue to introduce death and dying.