What are cultural considerations in nursing?

In our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

In a larger sense, practicing culturally competent nursing means more than understanding and acknowledging specific cultural differences. It also calls for seeing patients through a lens of cultural understanding, always striving to recognize and respond to each patient’s differing language, customs, and beliefs. 

To prepare to practice with cultural competence, a nurse can become familiar with the elements of culturally competent healthcare and strive to apply them with compassion and respect to every patient they encounter.

Know the Elements of Culturally Competent Nursing

Learning to deliver culturally competent nursing care takes effort, but the reward of bridging the cultural divide to give better care is well worth it. The following are five components to know and practice.

1. Cultural Awareness

Culturally competent nursing begins with awareness — an in-depth reflection on a nurse’s own cultural beliefs and practices related to healthcare. Consider questions such as these:

• Does your culture postpone doctor appointments in favor of trying home remedies? 
• Does your culture practice dietary restrictions or customs related to meals and nutrition? 
• Does your culture talk about illness? Who makes the decisions about care?
• Does your culture have important birthing or end-of-life customs?

Quizzing yourself about your own cultural background and how it affects your healthcare choices is a key first step in understanding others’ views. Various cultural assessment tools can also help you explore your awareness of your cultural attitudes toward healthcare.

2. Cultural Knowledge

Learning as much as possible about other cultures is an important step in understanding people and providing them with culturally competent care. Explore websites, journal articles, books, college courses, and workshops for in-depth discussions of the cultures of groups you may serve, as well as other groups. 

3. Cultural Skill

According to Diversity Nursing, cultural skill is a measure of a nurse’s ability to “collect relevant cultural data regarding the patient’s presenting problem and accurately perform a culturally specific assessment.” Nurses who develop cultural skill can better gauge and respond to their patients’ health issues. They can customize their approach to caregiving based on what they know about each patient’s culture. 

Specific models for best practices that support developing cultural skill include the Giger and Davidhizar Model of Transcultural Assessment. This model—designed to help student nurses tailor and deliver culturally competent care—assesses cultural differences in six areas: communication, time, space, social organization, environment, and biological variations.

4. Cultural Encounter

Developing cultural competence in nursing is an ongoing process. The way to continually grow as a culturally competent nurse is simple: Interact often with patients from all cultures. Cross-cultural interactions deepen understanding.

5. Cultural Desire

A motivated culturally competent nurse wants to engage with other cultures and learn from them. Willingness to be open to other cultures generates the understanding and respect that result in culturally competent nursing — to the benefit of patients and caregivers alike. 

Overcome Common Communication Barriers

Often, people of different cultures speak different languages, which can cause confusion for patients and caregivers who don’t speak the same language. Miscommunication in healthcare can have serious repercussions. For example, communication barriers can affect patients’ willingness to accept treatment and their ability to understand explanations about their own health needs. 

At minimum, culturally competent nurses should:

• Listen carefully to patients
• Avoid interrupting
• Ask follow-up questions
• Be sensitive to nonverbal cues

Nurses should also think about word choice when speaking with patients. Avoid phrases that might offend. For example, don’t label a patient’s culture by using terms they don’t use to refer to themselves, such as categorizing a Spanish-language speaker from the Dominican Republic as “Spanish.” Referring to U.S. citizens as “American” can be off-putting as well, because Central and South Americans, for instance, are also American. 

When nurses and caregivers don’t share a common language, using translators and interpreters is critical. A colleague might serve in this role, or the patient might bring a family member who can assist. Either way, be sure to allow enough time for full communication to take place.

Examples of Culturally Influenced Miscommunications

Culture affects communication in unexpected ways. For instance, non-English-speaking patients getting mammograms or other technical procedures might hesitate to say they don’t understand the technician’s medical jargon. In another situation, a patient might misinterpret the term “Medicaid” as the name of an illness.

Furthermore, in some cultures, only designated family members, often the eldest man, make important decisions about a person’s healthcare. This can cause communication breakdowns in the examining room. For instance, a female patient who seems reluctant to accept treatment might be deferring the decision to a husband or son who isn’t present, a circumstance a nurse might misunderstand.

Finally, good communicators don’t stereotype. Avoid assuming that an individual’s way of expressing themself, or the opinions they share, reflect a cultural stereotype (“all members of this group are this way”). In addition to respecting cultural differences, culturally competent nurses respect each patient’s uniqueness.

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