The number of nurses with advanced degrees has increased, and more minority students are finding a place in healthcare professions. Despite these developments, the American healthcare system has struggled to establish a universal standard for culturally competent care.
Part of the problem is that ethnicities and genders have long been underrepresented in the healthcare workforce. Less than 19 percent of registered nurses come from a minority background, and less than 11 percent of nurses are men.
Meanwhile, the United States as a whole is becoming a majority-minority nation. The U.S. Census Bureau reports that minorities made up approximately 37 percent of the population in 2012 and are projected to comprise 57 percent of the population in 2060. While 2060 is still decades away, the cultural gap already exists and has proven unfavorable for the health of minorities.
Consider the case of an elderly Irish woman, who was hospitalized and then scheduled for surgery. The woman complained of pain to her family but said nothing to her physician. Hiding pain is a general characteristic of Irish women. Unaware of this cultural tendency, the physician denied the family’s request to move up the surgery date. The woman’s condition worsened and she died during surgery. If a culturally competent nurse had intervened, the Irish woman may have had an entirely different outcome.
Another example is in Chinese culture, where a Chinese patient may be showing respect to a physician by avoiding eye contact. In American culture, a lack of eye contact can be considered rude or an indicator of depression. In both Muslim and Navajo cultures, eye contact has other distinct meanings. Understanding the nuances between cultures and how language has different meanings for different people is crucial when treating patients of backgrounds different from one's own.
As the bridge between practitioners and patients, nurses are in a unique position to respond to the growing demand of a diverse population. If nurses can propel the healthcare industry toward cultural competency, they can significantly reduce health disparity and ensure quality healthcare for all populations.
It's not just a catchphrase. Cultural competency refers to the ability of healthcare providers to recognize and respect patients with diverse values, beliefs, behaviors and linguistic needs. The National Institutes of Health (NIH) describes it as “the combination of a body of knowledge, a body of belief and a body of behavior” because it requires healthcare professionals to understand cultural differences and respond accordingly. The intersection of knowledge, beliefs, and behavior is where patient care can be affected.
The American Hospital Association says that “a culturally competent healthcare system is one that acknowledges the value of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs.” It may sound like a tall order, but each of these action items is achievable. More importantly, they are necessary for healthcare systems to meet the demand of a diverse population.
Of course, it’s not enough to solely understand the definition. Healthcare facilities must also integrate policies that cultivate cultural respect. Some effective strategies for achieving culturally competent care and reducing health disparities include the following:
Source:Medical Care Research Review (Brach & Fraser, 2000)
Providing interpreter services
Interpreter services improve communication between patient and provider. Organizations should always test the competency of those providing language assistance and avoid using untrained or minors as interpreters. It is also helpful to supplement interpreter services with print materials and signage in languages most commonly used by the population.
Recruiting and retaining professionals with minority backgrounds
A successful recruitment strategy invites human resources and other hiring staff to present a culturally mixed set of eligible candidates. To retain a diverse workforce, an organization must incorporate cultural attitudes and messages in internal communications leading to increased trust in the workplace.
Training staff to improve cultural awareness and skills
Because each minority group is composed of subcultures, it is impossible to train employees in-depth about all cultures. A more successful approach is to educate healthcare providers on traditional beliefs and behaviors among the cultures most commonly served by that organization. Consistent training expands a staff’s knowledge base so that they can provide the most culturally appropriate treatment options.
Coordinating with traditional healers
Not all cultures accept Western medicine as their primary source of healthcare. Therefore, it is necessary to understand the role of traditional healers and coordinate with them to provide adequate patient care. This allows patients to follow their treatment program within their cultural parameters, which leads to patient satisfaction and improved health.
Using community health workers
Another valuable partnership is the one with community health workers. When pulled into the process, these professionals help bridge communication between health professionals and patients from underserved communities. Their role results in improved patient education and health outcomes.
Incorporating culture-specific attitudes in health promotion
Before implementing health-promoting programs, organizations must acknowledge any existing imbalance between minority groups. If one group is more at risk of a particular health concern, that should be addressed and presented from that specific cultural perspective. This helps the health institution establish credibility among the minority population.
Including family and community members in healthcare decision-making
Involving family and community members in healthcare issues builds trust and breaks down disparities between cultural groups. This can be accomplished with something as simple as an advisory committee. For optimal results, these committee members should represent a diverse set of values and perspectives.
Expanding services into culturally dense cities and towns
The health status of minority groups will never improve if services are not accessible to these patients. Therefore, healthcare providers must invest their time and resources into underserved communities, where their care is missing most. This will likely require select skill sets to overcome poor health literacy.
Establishing linguistic competency among administrative and operational staff
A routine doctor’s visit involves much more than interacting with the healthcare provider. Staff in billing, medical records, and human resources are all key players in the healthcare experience. Through cultural training and interpreter services, staff members can provide much more attentive care. As a result, the patient walks away satisfied with the entire healthcare team.
Nurses are often the first and last points of contact with a patient. Therefore, their role in healthcare is more intimate compared to other staff members within the organization. To help nurses develop cultural competency and deliver customized care, Josepha Campinha-Bacote and Cora Munoz developed a five-prong system.
These are only some of the ways nurses can cater to a diverse patient group. It is also essential for nurses to support healthcare facilities, nursing schools, and professional associations in their programs to improve diversity. Establishing cultural respect is a collaborative effort that requires all hands on deck.
It is also worth noting that cultural competency is a continuous process rather than an endpoint. As patients’ needs evolve, these changes will dictate how cultural diversity is addressed throughout the healthcare industry.
In an increasingly diverse environment, it is critical for healthcare providers to adopt cultural standards and amend them as needed. Nurse practitioners, for one, can leverage their in-field experience to affect change and lead this industry into the future—one in which everyone has access to quality care, when and how they need it. After all, that is culturally competent care.