Multiculturalism

Today, nurses work with a growing diversity of both colleagues and patients, therefore it is very important to recognize cultural diversity and understand the meaning of culture. The main problems in caring for patients from diverse cultural backgrounds are the lack of understanding and tolerance. Developing cultural competence is an ongoing process. For nurses, it is very important to demonstrate that they are not only clinically proficient but also culturally competent. Because lack of culturally appropriate care affects patients’ experience, it is very important that nurses use different strategies to promote and practice cultural competence. The strategies that nurses can use are recognizing differences (biological and cultural), using proper communication skills, and understanding specific cultural beliefs.
Culture influences how people seek health care and how they behave toward health care providers. Some cultural groups have different approaches to their disease problems therefore, health care providers need to have the ability and knowledge to communicate and understand health behaviors influenced by culture. Having this ability and knowledge can eliminate obstacles to the delivery of proper care. Cultural competency is a complex developmental process, which includes an understanding of one’s own culture, values, and beliefs. It also includes the awareness and acceptance of cultural differences, recognizing that different groups have their own way of communicating, behaving, problem solving, and interpreting health and illness (Gibbons & Servonsky, 2005).
In our society, nurses do not have to travel to other places to see cultural diversity therefore, with an increase of culturally varied patient populations, it is essential for nurses to recognize these differences. Nurses should incorporate knowledge of biologic and cultural variations in their assessments and care plans. For example, skin color variations in African Americans might make it difficult for nurses to assess inflammation, jaundice, or cyanosis. For that reason, they should assess the patients’ other body parts in order to recognize signs and symptoms of their health problems. In addition, African Americans may respond differently to medications so it is very important to pay close attention to any changes after medication administration (Denman-Vitale, Green-Hernandez, Judge-Ellis, and Quinn, 2004). Patients of Asian heritage have a high incidence of lactose intolerance. As a result, it is essential to watch their dietary habits (Denman-Vitale, et al., 2004). Native Americans may wear ceremonial pouches, so nurses or other health care professionals should not remove these pouches during the physical examination. Religious beliefs may also affect how nurses can perform assessments. For example, Muslim men may not want to be touched by a female care provider (Denman-Vitale, et al., 2004). Recognizing these cultural and biological variations will help nurses better understand what is going on with their patients and what they should do or should not do during physical examinations.
With the importance of recognizing diversity, nurses should also know how to use their communication skills. Communication skills begin with the ability to communicate effectively with those of other cultures. This deals with everything from the need for interpreters to nuances of words in various languages. Many patients are reluctant to talk about personal matters such as sexual activity or chemical substance use for that reason; nurses need to learn how to ask questions sensitively and in a nonjudgmental way. For instance, Arab husbands may accompany their wives for health visits and act as interpreters limiting confidential communication with female patients. In this case, it is important that nurses discuss with the family the need for a same sex interpreter so they can provide necessary care for these patients. Furthermore, nurses can learn some important phrases in at least the most common languages to facilitate accurate communication (Denman-Vitale, et al., 2004). Effective communication is a fundamental component of nursing practice, but respect for the belief systems of others and the effects of those beliefs on well-being are critically important as well.
Most of the world’s cultures have beliefs about the causation, diagnosis, and treatment of the disease. For example, Western medicine is focused on the germ theory of disease using blood tests and other diagnostic tools for disease detection, whereas some non-Western cultures believe that illness is caused by object intrusion, spirit possession, soul loss or taboo (Reznik, Cooper, MacDonald, Benador, and Lemire, 2001). For instance, the Hmong culture has a very different approach to the illness process and it is often contrary to Western medicine. “The Hmong often seek the care of a txiv neeb, a shaman or Hmong spiritual healer” (Reznik, et al., 2001, p.28). So showing respect for different cultural beliefs and using negotiating techniques in terms of what kind of practices can be used will allow nurses to create care plans in order to achieve the ultimate goal, the well-being of their patients.
Culture is inseparable from the person therefore, showing sensitivity to the needs and culture of the populations being served is essential (Sharon, Censullo, Cameron, and Baigis, 2007). Using different strategies will improve the ability of the nurses to deliver appropriate care to culturally diverse clients and help them in the process of becoming culturally competent. In addition, according to Rosehjack Burchum (2002), culturally competent care will be better received by the client and will result in increased client satisfaction. Finally, approaches such as recognizing cultural differences, using proper communications skills, and understanding specific cultural beliefs will help the nurses to provide the best possible care for their culturally diverse patients and help them to establish a respectful provider-client relationship.
Intervention # 1
In order to provide culturally competent care, it will be beneficial for nurses to have thanscultural education, which will help them to understand how patients perceive their health problems.
Disadvantage # 1
Cultural education is the best possible way to provide knowledge about different cultures; unfortunately, this training cannot possibly cover the uniqueness of every culture and give detailed information about the traditions, beliefs, and taboos regarding that particular culture. Its major disadvantage is being limited to general cultural concepts and because of that, in some situations, even being culturally educated will not help the nurses to be fully prepared to provide ethnically knowledgeable care for diverse clients. For example, trying to treat a Vietnamese person with head injuries can present difficulty: “Some Vietnamese consider the head to be sacred and housing the soul, and touching the head can allow the soul to escape” (Anonymous, 1999). Likewise, Chinese people may refuse lab work because “they believe blood is the source of life and that taking any of it could lead to their death” (Anonymous, 1999). Not every nurse, but especially one who is not of that culture or ethnicity, can be expected to understand fully or even know about such cultural nuances, which can affect the possibility and/or quality of patient care.
Disadvantage # 2
In addition to the limitations of knowledge to some cultural concepts, another disadvantage of cultural education is that it does not create any situational scenarios where students can practice to become clinically competent; in essence, the nurses are not given the opportunity to have real-life (or close to real-life) experience with unusual patient scenarios, which would help them be more prepared to deal with a wide range of culturally-relevant situations. Role-playing is a useful teaching strategy where students can demonstrate their ability to care for a patient in a culturally sensitive and appropriate manner: “Role play is a dramatic technique that encourages participation to improvise behaviors that may be encountered in nurse-patient situations. Using this technique, participants may test behaviors and decisions in an experimental atmosphere without risk of negative effects in a relationship” (Shearer & Davidhizar, 2003).
Intervention # 2
Nurses should share their own cultural backgrounds, observations, and possible impacts of cultural factors with each other, thus enhancing their cultural competence and competence of fellow nurses.
Disadvantage # 1
For some people, it is difficult to share their own culture. According to Yearwood (2006), “the individual may feel on the spot or negatively pressured to examine their personal worldview and values; therefore, concerns may exist that differences will be perceived as biased or insensitive” (p.161). Also, sharing one’s own culture may be perceived as an invasion of one’s own privacy, which will serve as a barrier in getting to know someone else’s culture.
Disadvantage # 2
In addition to the above-mentioned barrier, another exists as well: the notion of culture is too broad. There are many cultures and which one or ones should a nurse know? According to Yearwood (2006), culture and cultural diversity may be a “problem” because “for some, it could be viewed as too broad, fluid, dynamic, complex, and difficult to measure thereby rendering it marginal and it correctly represents the absence of a fixed state, thereby rendering it unpredictable. So individuals may distance themselves because of this unpredictability” (p. 161). A possible solution to the “problem” of culture and cultural diversity involves encouraging people to examine, talk about, and feel comfortable to explore multiple views because cultural factors do matter in practice, patient education, and colleague interactions.
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