The greatness of the United States is founded on many people making their way here and establishing roots. With the advent of an increasingly aging and diverse population discussions in patient centered care must include cultural sensitivity. Nurses, who are the most numerous of health care professionals and provide the majority of care, will be the key determinant in health care outcomes. Culture does influence a patient's perception of health, wellness, illness, pain and death.
Nurses who provide culturally sensitive care will create the opportunity for the ideal outcome.
Madeline Leininger was the first to realize many decades ago that true nursing care must include an understanding of the patient’s culture. She was the pioneer of transcultural nursing at a time when the concept was not conceived or discussed by mainstream health care. She realized that a patient’s idea of health care would influence whether they responded to treatment. She also advanced the theory of viewing the whole person and understanding the context/environment in which they lived.
In an interview with P. Clarke, the contributing editor of Nursing Science Quarterly, she relates how she persuaded Cincinnati University to get Margaret Mead as a speaker on the topic of care and culture. Dr. Mead’s question to the first doctor who presented was, “what do you know about the cultural background of the patient and the family?” He said he knew nothing. She then told him he should not be doing any treatment or care. Dr. Leininger had gone so far as to suggest the Psychoanalytic Institute be shut down because “there was nothing there about care or culture.”
Historically nursing had followed medicine’s lead in focusing on curing, diagnosis, and medical symptoms. With her leadership, she was able to increase the number of nurses interested in transcultural nursing, from the few that were military, missionary, or community nurses. Part of their effort to create widespread interest involved starting The Journal of Transcultural Nursing in 1986. 20 publishers were approached and none expressed interest in this never before heard of idea of culturally sensitive nursing. The publishers also did not see the merit in a theory that was not approved by the medical profession. But Dr. Leininger persisted and today the Journal of Transcultural Nursing is accompanied by its website and has a global reach.
So how far has culturally sensitive nursing come in the last few decades? Do nurses see cultural competence as important? If the nurse is part of the dominant culture should she or he care about other cultures? The answer would be yes, because nursing values demand the application of social justice. Nurses are committed to reducing or eliminating health disparities. Health disparities can exist in part because of how different cultures are perceived and treated. So nurses need to ask: What is the how of becoming culturally competent? The process or journey begins with awareness on the part of every nurse. That awareness would include an examination of one’s attitude towards different cultures and an understanding of what the word culture encompasses..
According to Purnell and Palunka (2003) there are primary and secondary characteristics of one’s culture. The primary characteristics are age/generation, nationality/race, gender, and religion. The secondary characteristics are educational achievement, occupation, socioeconomic and marital and parental status, rural or urban location, sexual orientation, physical characteristics, and if an immigrant reason for migration. An understanding of one’s primary and secondary characteristics of culture will determine the extent of a nurse’s adherence to the dominant culture. Awareness of these characteristics also will help one become aware of one’s own unconscious biases or stereotypes one holds about other cultures. A cultural group can be based on different factors, not only the ones that immediately come to mind about people from other countries. For example, the Deaf can be considered a cultural group, as are the elderly and homosexual people. This is the beginning of the process to be open to cultural encounters. Then nurses can ask how they can become culturally sensitive and competent.
Nurses must first realize that each culture has a different perception of health care and its aspects. The particular culture’s attitude towards health care is also influenced by what they perceive as their position in the overall US society. There can be no doubt that patients have an understanding that certain cultures are more dominant in the US health care system. Thus their perception of health care and medical professionals will be affected, which in turn will affect the success of any treatment or education on wellness.
Any effort to increase cultural competence must involve a deliberate effort, collaboration, it must produce measurable results, and be evaluated on a regular basis. Above all cultural diversity must be respected and positively acknowledged and appreciated.
Any organization that is serious about culturally sensitive care must start with an understanding of the community they serve. What is its cultural makeup? Are communications with the community planned with n goal of the majority of recipients being able to understand in their own language? Is there an understanding of the level of health literacy of patients? Does the board of the organization reflect the diversity of the patient population? Are satisfaction surveys presented in enough languages to obtain a statistically significant result?
If the medical center is a hospital, nurses can help accommodate patients to navigate the hospital rules around visiting hours and preferred foods for example. This reduces stress for the patient and family which in turn can increase success of treatment and compliance.
Madonna University and the University of Michigan have been given a 3 year grant from the HRSA Department of Health and Human Services. They along with the Transcultural Nursing Society are providing training opportunities to health care organizations to train their staff in cultural competence and if they wish to acquire certification as a transcultural nurse. These health disparities from the Healthy People 2020 will be emphasized: obesity, depression, low birth weight infants, hypertension, diabetes, among others.
There is unprecedented opportunity to foster a spirit of learning from colleagues, especially as the number of nurses from diverse backgrounds is increasing in the US health care system.
Dr. Leininger’s motto in 1960 states in part:
“That we will become one united world culture for unity good health, peace and goodwill…”
Culturally competent nurses are in a position to eliminate inequities so that all citizens have maximum opportunity for good health.
- The American Academy Nursing Expert Panel Report Journal of Transcultural Nursing April 2007 Vol. 18 No. 2 pp 95-103
http://www.cultural-competence-project.org/en/about.html
http://ezinearticles.com/?American-Nursing-Today---Culturally-Competent-Care&id=1232555
http://www.tcns.org/Foundress.html
Caring: Some Reflections on the Impact of the Culture Care Theory by McFarlane and Andrews and a Conversation with Leininger. Nursing Science Quarterly July 2009 Vol. 22 No 3 pp 323-329
Journal of Transcultural Nursing April 2011 Vol.22 No 1 pp. 5-14
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