Guidelines for Culturally Competent Nursing Care

November 29th, 2011


By , BSN, RN

In my nursing job I meet people from all over Texas, from all over the United States and, from all over the world. Like most nurses I help care for people from diverse ethnic, religious and socioeconomic backgrounds. It is a challenge to meet the needs of all these different clients, and it is a challenge to do so in a way that works with their individual beliefs, lifestyles and environments. It is called cultural competency, and it is a never ending lesson in a nurse's career.

Twenty years ago the American Nurses Association (ANA) stated that "culture is one of the organizing concepts upon which nursing is based and defined." Cultural competency is considered so important it is taught in the first semester of nursing school and reinforced throughout the educational process. Every Fundamentals of Nursing textbook has chapters dedicated to the topic, and those chapters usually fall within the first couple hundred pages.

According to the ANA, nurses need to understand how cultural groups understand life processes, how cultural groups define health and illness, what cultural groups do to maintain wellness, what they believe is the cause of illness, and how healers care for and cure members of cultural groups.

Because the nurse is expected to provide individualized care based on as assessment of the client's physiologic, psychologic, and developmental status, the nurse must understand how the client's beliefs and practices affect health and illness.

As nurses, we can improve our own cultural competency by following a few guidelines:

  1. Be self-aware-Examine your own belief system. Know your own cultural values. Only by knowing one's own culture can you be ready to learn about someone else's.
  2. Be aware of the client's culture as described by the client-It is important to avoid assuming all people of the same ethnic background have the same culture. For example: In the US we are northerners and southerners, east and west coasters, or maybe from the flatlands of the Midwest. We may know what to do in a hurricane but have never been in a snow storm; we may grow up on a farm or in New York City. We may share a skin color but have totally different frames of reference. This holds true for people from all over the world. Do not assume.
  3. Practice unbiased communication-Refrain from making judgments based on personal experience or limited interaction. Use politically correct communication at all times and address each client formally (Mr., Mrs., Sir, Ma'm) until otherwise indicated. Give your time and attention fully to each individual client. It is during this interview time, the history and physical, that individual beliefs and preferences will be identified.
  4. Form a plan of care that incorporates the client's culture-You must understand the patient's support system. Will they only receive care from family members, or will their community or church be involved? Are there economic barriers to care? You may suggest a one-drop medication that addresses multiple symptomsbut if it costs $100 and the client can't afford it, maybe consider two or three less expensive drugs found on the pharmacy $4 list that can do the same thing for a tenth of the cost. Other considerations may include: are non traditional healers involved; does the client have access to transportation; and are there religious or legal issues at hand that could impede care?

It is important to understand that nurse-patient interactions include the three cultural systems: the culture of the nurse, the culture of the client, and the culture of the setting. Access to care can be improved by providing culturally-relevant, responsive services.

There are great disparities in healthcare in this country. We are a society of haves and have-nots, and with the current economic struggles many people face it is a fine line between the two. This week your patients may have a home and insurance and next month that same family of five is living in their car. Their cultural needs change and we must be aware and flexible. The US is a melting pot of ethnicities, religious beliefs, economic status and languages to name a few of the ingredients. As nurses, we are bound to deliver the best possible care in a manner that is recognizable, doable and respectful for each different client.

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