The Importance of Cultural Competence in Nursing

Introduction: We are living in a global diversity where different cultures, religions, traditions, and spiritual beliefs play important parts in making our lives. As in the United States, the growing diversity has been seen for decades and continues to widen; however, the same cannot be applied for our healthcare professionals’ population in our country. Thesis statement: Because of the lack of parallel growth in diversity between general population and healthcare professionals, it suggests significant impact on healthcare delivery in which minority patients might receive culturally discordant medical care. Background: Research has shown that there are significant disparities in healthcare existing between groups of patients who are different on the following, but not limited to gender, race, and ethnicity. Because every culture is unique, and each has different sets of perspectives on healthcare, it is easy for us to misunderstand one another and formulate our unconscious bias. Unconscious bias of healthcare providers about a particular culture can lead to ineffective cross-cultural healthcare services. Therefore, knowing who we are and where we stand, and being aware of a person’s culture frame of reference is important to understanding of the person as well as to reducing cultural discordance in the healthcare settings.

Campinha - Bacote’s Model of Cultual Competence

Evidence & citing: According to Kelly (2014), cultural diversity goes beyond the definition of traditions, customs, practices, beliefs, and values of the diverse groups. Other faces and subcultures include thoughts, language, occupational or professional affiliations, nationality or race, age groups, gender, socioeconomic factors, sexual orientation, political viewpoints, etc. Topic sentence: With the knowledge of growing cultural diversity and long- existing health disparities within diverse groups, it is important for us to provide and practice culturally competent care that is consistent with the patients’ cultural needs. Evidence & citing: Campinha- Bacote’s model of cultural competence, which includes the integration of cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire, provides a framework for developing and implementing culturally responsive healthcare services in which healthcare providers continuously strives to achieve the ability to effectively work within the cultural context of the patient.

Topic sentence: One of the main constructs of Campinha-Bacote’s model of cultural competence is cultural awareness, which is “the self-examination and in-depth exploration of one’s own cultural and professional background” (Campinha-Bacote, 2002). Evidence & citing: Cultural awareness is needed for every nurse because it could help guide decision making, become more open to new experiences, and learn from the interactions with others. Commentary: Moreover, as the population of the United States are becoming extremely diverse which largely because of immigrants who have arrived in the past generations, registered nursing, in the other hand, is not as racially and ethnically diverse as the country’s population. Evidence & citing: According to Moore and Continelli (2016), nurses in the United States are predominantly white. In 2008, the major population of nurses was estimated “83.2 percent white (vs. 65.6 percent of the U.S. population), 5.4 percent black (vs. 12.2 percent of the U.S. population), 3.6 percent Hispanic (vs. 15.4 percent of the population), and 5.8 percent Asian (vs. 4.5 percent of the population)” (Moore & Continelli, 2016). These numbers greatly represent that racial discordance in medical care is prevalent, such as there are 15.4% of the US population is Hispanic, yet only 3.6% of the nurse workforce is Hispanic. Commentary: Thus, the need for culturally competent nurses cannot be overemphasized enough. Without being culturally competent, culturally discordant care arises from unaddressed cultural differences between nurses and their patients.

Topic sentence: I, as a nursing student, also need to practice cultural competence. It is an on-going process which means that I need to continue learning and implementing throughout my nursing career. Commentary: Thereby, prior to taking care of a patient whose culture is different from mine, it is essential for me as a nursing student to examine my own cultural identity and biases in order to avoid cultural imposition and to understand my patients more. Evidence & citing: For me, I identified myself as a foreign-born Vietnamese woman whose culture is greatly based on traditional values taken from my home country. I value my family and friends, education, spiritual beliefs, and success.

Topic sentence: A Vietnamese elderly patient who has low literacy level, especially if he/she cannot understand English, often present a challenge to me. I used to work in a doctor’s office where the majority of patients are Vietnamese elderly. As embedded in their culture, old generation of Vietnamese often underestimate the importance of their illness and place a strong emphasis on appearing healthy and active, which it is referred to as the maintenance of “face”. Because of this belief, it blinds them from understand the need of health care and cause them to less likely to seek for one when they need it. Also, the majority of them also have limited English proficiency which make it difficult for them to comprehend their medical diagnoses, medications, and treatment options, and lead them to experience barriers to health care, such as low access to health services and receiving less favorable outcomes. I was, for multiple times, encountering patients who denied taking their blood pressure and cholesterol medications because they thought they were fine, and the medications were toxic to them. Evidence & citing: I had a story about a female patient whose age was around late 50’s. She had history of medical noncompliance in which she did not take her medications as prescribed. One day, as she came for her routine health exam at the doctor’s office, she complained of pounding headache, blurred vision, and her systolic blood pressure read over 200 mmHg and diastolic blood pressure was above 100 mmHg. Based on the initial assessment and her recent hospital admission due to severe hypertension, the doctor recommended her to go the emergency room for further diagnostic check-up. However, the patient refused because she was afraid of hospitals and she did not see the need for emergency care at the moment. She stated that last time when she got admitted, it cost her a lot of money for merely a fluid transfusion and a couple of blood pressure medications. She preferred to have the doctor increase the dosage of her medications and let her go home. As the doctor and I tried to explain the potential complications of severe high blood pressure, the patient continued to refuse by saying that she just needed to rest for her headache to go away. Based on the story of this particular patient, I found it difficult, yet important to help this vulnerable population of patients whose health literacy level is low and whose English is not their first language. Commentary: The patient that I described in the story was afraid to go the hospital not because of the expensive hospital bills, but mainly because she did not have anybody to go with her to help translate. When I talked to this patient, she stated that her children were all busy and that she did not want to bother them. Moreover, not only this patient, but most of Vietnamese older adults also have the same struggle. In addition, many Vietnamese elders like to treat themselves at home using traditional herb medicine and nonpharmacological alternatives. Due to this cultural influence, it prevents them from going to their doctors routinely and from seeking expert medical care when needed.

Conclusion paragraph: Thus, I think it is important to educate them in understanding the positive impact of getting professional medical care as well as to provide resources available to help them feel more comfortable when going to the hospital.

References

• Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership & management. Clifton Park, NY: Delmar.
• Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing,13(3), 181-184. doi:10.1177/10459602013003003
• Moore, J., & Continelli, T. (2016). Racial/Ethnic pay disparities among registered nurses (RNs) in U.S. hospitals: An econometric regression decomposition. Health Services Research,51(2), 511-529. doi:10.1111/1475-6773.12337