The Cultural Diversity of Patients and the Importance of Providing Culturally Competent Care

The 21st century has been an era of multiculturalism and diversity. With this increase in our ethically diverse population, the nurses’ ability to deliver appropriate care for all people is extremely important. Jennifer McBride

There are a number of barriers that separate people of different backgrounds, but unless those barriers are discovered and overcome the people in this world will never receive the healthcare that they need and deserve. Cultural competence in the nursing field is imperative in providing successful care to clients of different ethnic or cultural backgrounds. Nurses can accomplish this by first evaluating their own personal beliefs, educating themselves and others on skills needed to do cultural assessment, and by collaborating with a multidisciplinary team.
Lacking cultural competence is a huge problem in the health care industry. Cultural competence is knowing how to communicate with people of different backgrounds. It is knowing what biologic variations can present. Cultural competence is knowing about the client’s world view and how they view life, illness, medicine, gender and health care. Without this knowledge it is virtually impossible to provide people with adequate care. Communication is key in providing the healthcare provider with vital information about the client. Cultural competence by no means calls for the nurse to be fluent in all languages, rather to know how to get around these barriers. By not knowing how a client feels about medicine or women, for example, the nurse could very easily offend the client, which could cause the client to have a negative experience. Lacking cultural competence is a problem because of our ever growing diverse country. It is a problem because without it, people will not receive the care nor education that they need.
Becoming culturally competent is an ongoing process and the nurse must bring the willingness and commitment to change. Every person is to an extent, ethnocentric. Dennis and Small (2003) recognized that clarifying one’s own values is one of the most important steps in being culturally competent. Learning how to reduce our ethnocentrism is enhanced by realizing that there are many other cultures out there. Some of these cultures are similar to our own and some are very different. Some have practices that we like or dislike, but having an awareness to this helps us to treat our clients as individuals.
In order to achieve cultural competence the nurse must yearn for the following characteristics: cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters. (Potter and Perry, 2005) Cultural awareness is the examination of one’s own cultural background. This process involves the recognition of one’s biases, prejudices, and assumptions about individuals who are different. Cultural knowledge is the process of seeking and obtaining educational information about diverse cultural and ethnic groups. (Purnell, 2005) Obtaining cultural knowledge about the patient’s health related beliefs and values involves understanding their world view. Understanding the patient’s world view will help the nurse to interpret how the patient views their illness. Nurses can obtain this knowledge by doing research on different cultures on the internet or at the library. Cultural skill involves being able to accurately perform a culturally based, physical assessment. The nurse needs to know about biologic differences in cultural groups, whether that is skin color or metabolic differences. The nurse also needs to be educated on cultural beliefs about medicine, illness and healthcare. This will refine or modify one’s existing beliefs about a cultural group and will prevent stereotyping. Although it may not be an actual skill, cultural desire is the pivotal and key construct of cultural competence, for it is the nurse’s desire that evokes the entire process of cultural competence. Cultural desire includes a genuine passion to be open and flexible with others, to accept differences and build on similarities, and to be willing to learn from others.
During the assessment phase it is very important to take into account things such as variations between groups. Skin color is one of the most easily observable. Many skin conditions manifest differently in light and dark skin; anemia, erythema and jaundice are just a few (Dennis and Small, 2003) Nurses need to take into account the different biologic variations of clients while performing their assessments and developing a plan of care. Because of African American’s dark skin tone it may be difficult to diagnose inflammation, jaundice and cyanosis. Clients of Asian background have a high incidence of lactose intolerance. Some variations are not biological, but are still extremely important to recognize. For instance, Native Americans sometimes wear a ceremonial patch that keeps evil spirits away; these patches should never be removed by a health care professional. Because of their religious beliefs, Muslim men may not want to be touched by a woman, even in a health care setting. Knowing these variations ensures that the nurse will be able to provide the appropriate care and treatment.
Using a formally trained medical interpreter is sometimes necessary to facilitate accurate communication during the nurse-client encounter. The use of untrained interpreters, friends or family members may pose a problem due to their lack of knowledge regarding medical terminology and disease entities. This situation is heightened when children are used as interpreters. (Campinha-Bacote, 2003) Nurses can learn just a few phrases in the most common languages and this will help with being able to communicate with clients. Usually when a health care professional attempts to communicate with a client in their own language it makes them feel more cared for and can lower the communication barriers. Nurses need to have at least a minimal amount of knowledge about the culture and background of the client they are dealing with. Collaborating with multiple health care team members is also sometimes helpful in receiving new ideas and, or receiving help in dealing with clients. Another person may have a different perspective than the nurse, and this can sometimes be a good thing.
According to Servonsky and Gibbons (2005) some assessment strategies that demonstrate how nurses can deliver culturally competent care include knowing what questions to ask and how to ask them in a nonjudgmental way, being able to empower the family and its members and acting as a mentor so that the family is more involved in the health care process. All of these things point to having a therapeutic nurse-client relationship. Working on and implementing these strategies will help the client and family to feel comfortable. Empowering the family will allow them to trust their nurse. Servonsky and Gibbons (2005) define cultural competence as:
An understanding not only of one’s own culture, values, and beliefs, but the awareness and acceptance of cultural differences among groups and the recognition that diverse groups have their own way of communicating, behaving, problem solving and interpreting health and illness. (2)
This country is growing and becoming more culturally diverse every day.

Providing successful care to clients is ensuring that the world not only survives, but advances. Nurses need to have the skills and competence to care for these clients. There will always be barriers that attempt to separate people of different backgrounds, but there are ways to overtake them. By evaluating their own personal beliefs, educating themselves and others on skills needed to do cultural assessment, and by developing collaborating with team members, the nurse can and will be able to provide culturally competent care to clients of different cultural and ethnic background.

A. Evaluating one’s own personal beliefs.
i. Viewing own personal beliefs as superior to all others.
1. Narrative: In order to provide culturally congruent care it is first necessary to examine one’s own personal beliefs. This step is essential in becoming culturally competent due to its ability to allow one to recognize that there are many different cultures with many different views on everything from life, gender, illness and medicine. Although it is a vital step, it can have a harmful outcome. In knowing and understanding one’s own cultural beliefs, it is possible to view only those as right, and all other beliefs as wrong. The attitude that one’s own ethnic group, world view or culture is superior to all others is termed ethnocentrism (Taylor, 1998). This has a harmful affiliation with viewing all other differences as negative.
1. Journal citation: Taylor, Rosemarie. (1998) Check Your Cultural Competence. Nursing Management. 29 (8) 30. Retrieved February 2, 2008 from Proquest Database.
ii. Assumed similarity or stereotyping.
2. Narrative: Another possible fallout of being in touch with one’s own cultural beliefs is believing that all other cultural groups are similar. The assumption that every culture has similar beliefs and values can lead to staff conflict as well as poor outcomes for patients. In the American culture for example, it is common courtesy to have direct eye contact with whomever one is speaking to. To believe that all cultures feel this way can lead to negative client experiences. Some Asian cultures believe direct eye contact with superiors is disrespectful. To become multicultural is to realize that one’s values and beliefs simply reflect a single set of options among many (Taylor, 1998). Stereotyping is another possible outcome. It is possible to make assumptions and perceptions about people based on their ethnicity and cultural background. For example, just because it is known that many Asian cultures use medical practices such as cupping, burning and pinching, it would be inappropriate to assume that your Asian-American client also uses these practices. It is critical to know and understand practices among different cultures, but is wrong to assume that because someone is from a certain ethnic background that these practices are used in everyday life.
3. Taylor, Rosemarie. (1998) Check Your Cultural Competence. Nursing Management. 29 (8) 30. Retrieved February 2, 2008 from Proquest Database.
B. Educating self and others on skills needed to do accurate cultural assessment.
i. Not dedicating self to the process of life-long learning and research for the purpose of assessment findings.
1. Narrative: Knowledge about cultures and its impact on interactions with health care is essential for nurses, whether one is practicing in a clinical setting, education, research or administration. Culturally congruent care can only be achieved through the process of learning cultural competence. Therefore, one must become an empowered, active learner. Cultural competence is an ongoing process in which one is always attempting to become more culturally competent. (Campinha-Bacote, 2003) The problem with this life-long learning process is that many nurses believe that there is not enough time in the day. Yes, one may be exhausted after a twelve hour shift at the hospital; however, this commitment will result in high quality, culturally congruent care.
2. Journal citation: Campinha-Bacote, J. (2003) Many Faces: Addressing Diversity in Health Care. Journal if Issues in Nursing. 8, 1. Retrieved Jan 19,2007 from Proquest Database.
ii. Not providing an assessment individualized to the clients race or culture.
1. Narrative: Providing individualized care to each and every client is dependent on having knowledge about different cultural practices, beliefs and world views. However, providing individualized care also means that every person is unique and that one must take into account their cultural background without assuming that because that client is Muslim, Indian or Asian, that they have certain religious or cultural practices. Nurses sometimes have a tendency to make generalizations about clients based on their background. This goes hand in hand with assuming similarities and stereotyping. There is always a fallout to every good intervention, but knowing that these problems exist is what allows us to acknowledge it and not make the mistake.
References:
Campinha-Bacote, J. (2003) Many Faces: Addressing Diversity in Health Care. Journal if Issues in Nursing. 8, 1. Retrieved Jan 19,2007 from Proquest Database.
Dennis, B.P. & Small, E.B. (2003). Incorporating cultural diversity in nursing care: An action plan. ABNF Journal, 14 (9), 17-26. Retrieved February 8, 2007, from Proquest Database.
Hernandez, C.G., Quinn, A.A., Vitale, S.D., Falkenstern, S.K., & Ellis, T.J. (2004). Making nursing care culturally competent. Journal of Holistic Nursing Practice. 18, 215-218. Retrieved January 19, 2007, from Proquest database.
Potter, P. & Perry, A. (2005). Culture and Ethnicity. In S. Epstein (Ed.), Fundamentals of Nursing (pp. 120-133). St. Louis, Missouri: Mosby
Purnell, L. (2005). The Purnell model for cultural competence. Journal of Multicultural Nursing and Health, 11 (2) 7-15. Retrieved February 4, 2007, from Proquest Database.
Servonsky, J.E. & Gibbons, M.E. (2005). Family nursing: Assessment strategies for implementing culturally competent care. Journal of Multicultural Nursing and Health, 11, 51-56. Retrieved January 19, 2007, from Proquest database.