Culturally Competent Care

Modern Nursing Care: Stepping Outside of the Box

The last century has changed the face of healthcare. Modern global travel, immigration, and international business have made the world a cultural melting pot. The modern healthcare team must step beyond the small-town hospital, ‘mom-and-pop’ corner store feel, and take responsibility for providing culturally competent care for a patient pool that often literally represents the four corners of the globe. Because nurses are the bedside care, day in and day out, perhaps no other profession is so challenged or so rewarded by adjusting to today’s diversity.

Iberian, Central and South American Heritages

The Iberian, Central and South American heritages include a strong focus on family and often integrate a strong belief in the effectiveness of tradition. These cultures will be referred to as ‘Latino’.

Family

Latino culture tends to focus on family or communal needs over the needs of the individual. This collectivist mindset leads to extended family living in close proximity and to extended family often being intimately engaged in healthcare decisions for the individual. Healthcare providers should not be surprised if patients from a Latino culture expect to discuss important healthcare decisions with family before making a decision (Gallaraga).

Values and Physical Proximity

Latino cultures have a strong focus on the values of friendliness and respect. Latino patients will tend towards politeness and avoiding conflict. This may lead to diminished self-entity and to a lack of personal decision making. Asking Latino patients about personal and family situations can encourage a feeling of connection leading to increased openness and honestly. Finally, in Latino cultures it is common for people to stand in close physical proximity. A healthcare provider that is comfortable with close proximity may be seen as being more personable (Juckett).

Traditional Medicine

Herbal remedies play a prominent part in cultural medicine. Herbal teas or remedies are seen as having hot or cold properties. Hot remedies are used to treat cold conditions and vice-versa. Healthcare professionals need to be aware of which products or treatments are seen as hot or cold because Latino patients may discontinue taking vitamin pills, seen as a hot treatment, when presented with a rash which is seen as a hot condition. Various herbs may also interact with drug treatments and may need to be discontinued or altered (Juckett).

Making Decisions

The greatest power publicly in Latino households is held by the oldest male who will often take the lead in making healthcare decisions. Women in the household are expected by tradition to adhere to the man’s opinion. However, it is not uncommon for women to return to the provider alone if there is a disagreement and she wishes to exercise her own opinion (Gallaraga).

Asian Heritages

Asian cultures tend to focus on the holistic nature of life. The interconnecting roles of nature, spirituality, relationships, and physical well-being are all considered important aspects of healthcare.

Belief in Balence

Asian beliefs and traditions see the world as being built from polar or opposing principles. Examples include earth and heaven, winter and summer, night and day, inner and outer, body and mind (Carteret); opposing principles interconnect in a circular pattern and balance between opposing principles is believed to lead to total or holistic health.

Western medicine tends to believe that illness comes from a tangible source, like a pathogen or by the aging of the body, and sees disease as either mental or physical. Asian culture, in contrast, considers all systems to be inherently interconnected and believes that every organ has a mental or spiritual use as well as a physical function (Carteret). A healthcare provider aware of the mental, social, or spiritual facets believed to be interconnected with each organ is able to more completely understand patient communication. Healthcare professionals, when working with patients that come from Asian cultures, need to assess patient beliefs through open communication and then, as possible, facilitate patient desired holistic healing.

Health Treatments

Many traditional treatments undergone by Asian patients must be understood by healthcare professionals. One example is a treatment known as “coin rubbing” which is a dermabrasive therapy where a coin in rubbed across the skin. The basis for this practice is a believe that the coin removes toxins leading to a renewal of blood and energy. This treatment, which results in ecchymosis, can be mistaken for abuse by an uneducated healthcare provider (Jin, Slomka, & Blixin). Cupping is another traditional Asian practice of which healthcare providers should be aware which involves using suction cups on the skin. This is believed to facilitate blood flow and healing.

Mental Health Considerations

The Asian culture has a negative attitude towards mental health problems which may lead patients to mask mental health issues. An alert healthcare provider may note symptoms of mental health struggles and can then provide effective education designed to encourage the patient seeking treatment. Immigration, adjustment, and altered expectations can all contribute to American Asians struggling with some form of mental health challenge (Jin, Slomka, & Blixin).

Communication

Depending upon location, healthcare providers may be challenged to find interpreters for Asian patients that lack English fluency. The resulting lack of communication may lead to unnecessary diagnostic testing. Studies show that patients that lack English fluency are less likely to apply for important routine screening tests (Jin, Slomka, & Blixin). Healthcare providers may seek a telephone translator to assist in communication or a bilingual list of common medical phrases can be helpful for routine procedures.

African Heritages

African heritage has historically been greatly influenced by the status of being a racial minority. Statistical research into at risk populations demonstrates that the African American population faces unique challenges. African cultures are in need of effective health education and personal empowerment.

Health Education

Statistically, ten percent of certified health educators are African American. There is a lack of educators able to provide culturally applicable health education (Hargreaves, et al.) Healthcare providers should encourage health literacy on topics like self-care and effective communication with healthcare providers. Such practices may contribute greatly to the overall treatment of individuals with an African heritage.

Respect

Especially when working with older patients who may have suffered from racial segregation it is important to develop clinical rapport. Use of terms like Mr. and Mrs. can contribute to the patients ease and encourage trust. (Hargreaves, al et.)

Knowledge about the Tuskegee Experiment where African American men with syphilis were recruited but never received the promised treatment is common in the African American community. (Hargreaves, al et.) This knowledge, along with a history of discrimination, is likely to make African Americans skeptical of healthcare providers—especially those who suggest using unproven treatments.

Traditional Medicine

Often African Americans attempt to use a home remedy before applying for medical care. A recent study shows that African American patients with osteoarthritis are less likely than Caucasian patients to seek joint-replacement and instead turn to traditional remedies (Eiser). This cultural tendency is linked to the matriarch of the house who, historically, was the source for roots and information about home remedies. Open communication within a trusting provider-patient relationship is essential to ensure that all home remedies synergize with medical treatments and are not contraindicated.

Western medicine focuses on disorders and treatments; African traditional medicine tends to involve more trust in the doctor’s healing powers and in the knowledge available in the culture. (Hargreaves, al et.) Healthcare providers who develop clinical rapport can encourage patient independence and promote personal health education by informing patients about the process of treatment. Patients educated within a trusting provider-patient relationship on the cause-effect nature of disease can more effectively bridge the gap between trusting the provider and taking personal responsibility for health decisions; educated patients are also able to more effectively merge traditional practices and evidence-based solutions resulting in a culturally acceptable, effective treatment.

References:

Carteret, M. (2011). Traditional Asian Health Beliefs and Healing Practices. Dimensions of culture: cross-cultural communications for healthcare professionals. Retrieved from www.dimensionsofculture.com/2010/10/traditional-asian-health-beliefs-healing-practices/

Eiser, A. (2007). Cultural Competence and the African American Experience with Health Care: The Case for Specific Content in Cross-Cultural Education. Academic Medicine, 82:176–183.

Gallaraga, J. (2007). Hispanic-American Culture and Health. 4-5. Retrieved from https://case.edu/med/epidbio/mphp439/Hispanic_Healthcare.pdf

Gordon, S., Hargreaves, M., Lieto, J., Vyjeyanthi, S., Perweiler, E., Scott, V., …Zulu, M. Health and Health care of African American Elders. Ethnogeriatric curriculum module-Stanford University. Retrieved from https://web.stanford.edu/group/ethnoger/african.html

Jin, X., Slomka, J., and Blixen, C. (2002). Culture and clinical issues in the care of Asian patients. Cleveland Clinic Journal of Medicine, 69(1): 53-4, 56-8.

Juckett, G. (2013). Caring for Latino Patients. American Family Physician, 87(1): 48-54.