Suggested Readings
(click on selection for reviews and more information)

Teaching About 
Culture, Ethnicity, and
Diversity : Exercises and
Planned Activities
Theodore M. Singelis

Patients and Healers in the Context of Culture  by Arthur Kleinman 

Culture & Nursing Care

 by Pamela A. Minarik

The Illness Narratives: Suffering, Healing, and the Human Condition

 by Arthur Kleinman 

Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life (Comparative Studies of Health Systems and Medical Care)

 by Shirley Lindenbaum

 

 

Cultural Competence

 

  To be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes.

Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and  to understand culturally influenced health behaviors.

In our society, nurses don't have to travel to faraway places to encounter all sorts of cultural differences, such as ethnic customs, traditions and taboos. The United States provides plenty of opportunities for challenges stemming from cultural diversity. To be culturally competent the nurse needs to learn how to mix a little cultural understanding with the nursing care they offer. In some parts of the United States culturally varied patient populations have long been the norm . But now, even in the homogeneous state of Maine where we reside, we are seeing a dramatic increase in immigrants from all over the world.  These cultural differences are affecting even the most remote settings.

Since the perception of illness and disease and their causes varies by culture, these individual preferences affect the approaches to health care. Culture also influences how people seek health care and how they behave toward health care providers. How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and  to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of  health care.  These issues show the need for health care organizations to develop policies, practices and procedures to deliver culturally competent care.

Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989)  list five essential elements that contribute to an institution’s or agency’s ability to become more culturally competent. These include: 

1. valuing diversity; 
2. having the capacity for cultural self-assessment; 
3. being conscious of the dynamics inherent when cultures interact; 
4. having institutionalized cultural knowledge; and 
5. having developed adaptations of service delivery reflecting an understanding of cultural diversity. 

These five elements should be manifested at every level of an organization, including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization.

Developing culturally competent programs is an ongoing  process, There seems to be no one recipe for cultural competency. It's an ongoing evaluation, as we continually adapt and reevaluate the way things are done. For nurses, cultural diversity  tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we CARE..

Meyer CR.(1996) describes four major challenges for providers and cultural competency in healthcare. The first is the straightforward challenge of recognizing clinical differences among people of different ethnic and racial groups (eg, higher risk of hypertension in African Americans and of diabetes in certain Native American groups). The second, and far more complicated, challenge is communication. This deals with everything from the need for interpreters to nuances of words in various languages. Many patients, even in Western cultures, are reluctant to talk about personal matters such as sexual activity or chemical use. How do we overcome this challenge among more restricted cultures (as compared to ours)? Some patients may not have or are reluctant to use telephones. We need to plan for these types of obstacles. The third challenge is ethics. While Western medicine is among the best in the world, we do not have all the answers. Respect for the belief systems of others and the effects of those beliefs on well-being are critically important to competent care. The final challenge involves trust. For some patients, authority figures are immediately mistrusted, sometimes for good reason. Having seen or been victims of atrocities at the hands of authorities in their homelands, many people are as wary of caregivers themselves as they are of the care.

As individuals, nurses and health care providers, we need to learn to ask questions sensitively and  to show respect for different cultural beliefs.  Most important, we must listen to our patients carefully. The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other's perspective.


    References :

1. Cross, T., Bazron, B., Dennis, K., and Isaacs, M. Toward a Culturally Competent System of Care,     Volume 1. Washington, D.C.: Georgetown University. (1989.)
 2. Meyer CR. Medicine's melting pot. Minn Med 1996;79(5):5 

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